Aaron Antonovsky - Unraveling The Mystery of Health - How People Manage Stress and Stay Well (JOSSEY BASS SOCIAL and BEHAVIORAL SCIENCE SERIES) - Jossey-Bass (1987)
Aaron Antonovsky - Unraveling The Mystery of Health - How People Manage Stress and Stay Well (JOSSEY BASS SOCIAL and BEHAVIORAL SCIENCE SERIES) - Jossey-Bass (1987)
Aaron Antonovsky - Unraveling The Mystery of Health - How People Manage Stress and Stay Well (JOSSEY BASS SOCIAL and BEHAVIORAL SCIENCE SERIES) - Jossey-Bass (1987)
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FIRST EDITION
First printing: February 1987
Second printing: April 1988
Code 8705
... . .
A joint publication in
The lossey-Bass
Social and Behavioral' Science Series
and
The lossey-Bass Health Series
Contents
Preface Xl
.
The Author XIX
References 195
Index 211
.IX
- •
In memory of my parents,
Isaac and Esther,
who died at 94 and 89,
from whom I learned about the sense of coherence
-
Preface
D
In 1970 a very concrete experience occurred which led to a fun-
E
damental turning point in my work as a medical sociologist. I
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was in the midst of analysis of the data in a study of adaptation
to climacterium of women in different ethnic groups in Israel.
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move toward this end, whatever their location at any given time?
E
The first answer I considered, as suggested in a volumi-
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nous literature, was that their life stressor experiences-stressors
ranging from the microbiological to the societal-cultural levels-
were low. But, I argued, this hypothesis is untenable. In the very
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voted to reviewing the empirical evidence which suggested that
E
the SOC-health hypothesis was plausible. There were studies
whose findings linked given variables to health withou t offering
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explanations. Other studies proposed ad hoc explanations of
such linkages. In both cases, I suggested that the SOC construct
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ideas.
M OP
concern with the ever less humane overtones of the focus on the
organic pathology of diseases, the beginning of a movement
toward self-care, a growing awareness of the role of social fac-
tors in shaping well-being- all these set the stage for a serious "
consideration of the origins of health. Salutogenesz"s has a long
way to go before it becomes a household word like al£enatz"on;
and the sense of coherence is still, to my discomfort, all too
often called the sense of control or the sense of cohesion. But
the concepts have begun to take hold; the mode of thought has
become more familiar.
Health, Stress, and Cop£ng was written as a culmination, a
pulling together of the variety of research problems with which
I had wrestled for well over a decade. I had no clear audience in
mind. What the book did, I believe, was propose a model and
set an agenda. The present volume takes up the items on this
·
XIV Preface
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confronted with human struggles in a stressful world. I should
E
also like to think that the book will be meaningful for those
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who make up my own primary reference group, medical sociol-
ogists. I find it somewhat distressing that we have largely left
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as the quip has it, as broken down by age and sex) and others in
the realm of public health will, I believe, find my work most
O
D
from the published ideas of others. The three components of
the concept-comprehensibility, manageability, and meaningful-
E
ness-are presented, the concept of referent boundaries is intro-
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duced, and consideration is given to the distinction between the
strong and the rigid SOC. This chapter also includes a reconcep-
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events.
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D
build up the GRRs out of which a strong SOC emerges. This so-
E
cialization process is presented in a life-cycle framework from
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infancy through adulthood. The question of how .the SOC is
shaped leads us to an issue that, in my experience, is most dis-
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turbing for many of those who have been attracted to the con-
cep t: the dynamics of the SOC in adult life, and particularly the
L
R
ter Six, focusing on the pathways through which the SOC and
O
D
life satisfaction, or to successful task performance. Finally, I
E
seek to explain why, unequivocally rejecting understanding of
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the SOC as. a state characteristic, I find it important to see it as
what I call a dispositional orientation rather than a personality
ER RIG
cal research. Where such research will bring the model a decade
C
D
developmental disabilities agency with interest in strengths and
E
'resistance resources' rather than in the disability .... [Howex-
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citing it is] looking at the grins on our children's faces when
they see how good they really are, although different." If this is
the kind of impact my teaching and writing have had, I have
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D
Aaron Antonovsky is Kunin-Lunenfeld Professor of Medical
E
Sociology and chairman of the Department of the Sociology of
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Health in the Faculty of Health Sciences, Ben Gurion University
of the Negev, Beersheba, Israel.
ER RIG
Army during World War II; he was awarded the B.A. degree in
1945. He did his graduate workin the Department of Sociology
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at Yale University, where he had his first contact with the new
O
field of medical sociology, and was awarded the M.A. and Ph.D.
C
D
ments, and demonstrated responsibility.
E
In 1977-78 and again in 1983-84, he took sabbatical
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leave, serving as visiting professor at the School of Public
Health, University of California, Berkeley. At present, he has
embarked on a longitudinal study, supported by the National
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How People Manage Stress .
E
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and Stay »ell
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AT Y
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1
Toward a New View
of Health and Illness
•
D
Scarcely a week passes in which I do not encounter a paper to
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which my response is "My God, if only the author had thought
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salutogenically!" A recent example, possibly piquant: Lauden-
slager and others (1983) were concerned with the immunosup-
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hypothesis that the rats given inescapable shock would show the
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1
2 Unraveling the Mystery of Health
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tests are formulated in terms of research. Analogous questions
E
are applicable to the work of the practitioner.
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Let me be quite unequivocal about the two sources of the
salutogenic orientation. The first is the fundamental assump-
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Continuum or Dichotomy?
D
for here and there as I reread what I wrote, and occasionally lis-
ten to what I say in talking about the book, I find references to
E
pu tting the salu togenic question as "How come anyone ever
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'makes it'?" or "How can we explain health rather than dis-
ease?" Given the (in my view, most welcome) development of
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misin terpretation.
By and large, the health-oriented emphasis, no less than
the traditional medical disease-oriented position, is based on the
C
D
fined as a rehabilitation center. As one of sociology's classic dic-
E
tums has it, "If men define situations as real, they are real in
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their consequences." Since the study focused on the problem of
staff alienation, its major finding was that the "terminal ward"
nurses were far more alienated. We are not provided with any
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not apparent.
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causes the disease, is prevented from learning from advances in
E
other fields. And once again, those who focus on prevention of
specific diseases are subject to the same blinders.
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The concept of the story is taken from Cassell's profound
analysis (1979) of the medical concept of causality. In it he tells
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think in terms of factors promoting movement toward the
healthy end of the continuum. The point is that these are often
E
dzfferent factors. One moves toward it not only by being low on
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risk factor A, B, or C. In the field of stress research, the idea is
best understood if one contrasts the focus on stressors to the
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rather than what factors not only act as buffers but contribute
AT Y
been known that there are some factors that contribute to work
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Toward a New View of Health and Illness 7
D
During the past few years, when I have urged the saluto-
genic approach to colleagues, I have been amazed and delighted
E
at the fruitfulness of the hypotheses generated when one asks,
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"What predicts to agood outcome?" True, I am doubly pleased
when the sense of coherence (SOC) is seen as relevant to the
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8 Unraveling the Mystery of Health
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predict positive health consequences.
E
I t would, of course, be most valuable were studies de-
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signed in advance in these terms. But at the very least, surely
researchers should be open to looking at their results with such
a possibility in mind. Alas, this is seldom so, even when the
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data stare one in one's face. The illustration about shocked rats
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Toward a New View of Health and Illness 9
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nosed or on prevention of specific diseases, particularly among
high-risk individuals or groups. On the social level, it leads to
E
mounting wars against disease X, Y, or Z. The ambience that
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comes into being is that which Dubos (1960) so cogently
warned against, "the mirage of health." Salutogenesis, more pes-
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10 Unraveling the Mystery of Health
D
The terrible blow could not be recalled. But the Rehabilitation
E
Division of the Ministry of Defense had already arranged her
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move to a more spacious apartment, an adequate pension, fi-
nancial assurance of her children's education, and the like. The
diagnosis had been made, the therapy designed.
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whose death had made her a war heroine. She was often beaten,
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Finally, I would call attention to an unfortunate by-
E
product of scientific methodology that is ignored by the patho-
genic orientation. The good scientist formulates a hypothesis,
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when there is a basis for doing so, rigorously submits it to test-
ing, and rejoices when it is supported in repeated testing. Hav-
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do not move ahead.
E
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Pathogenesis and Salutogenesis:
A Complementary Relationship
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ease continuum. (2) It keeps us from falling into the trap of fo-
cusing solely on the etiology of a given disease rather than ,al-
ways searching for the total story of a human being, including
his or her sickness. (3) Instead of asking, "What caused (or will
cause, if one is prevention-oriented) a person to fall prey to a
given disease?"-that is, instead of focusing on stressors- we are
enjoined to ask, "What are the factors involved in at least main-
taining one's location on the continuum or moving toward the
healthy pole?"; that is, we come to focus on coping resources.
(4) Stressors come to be seen not as a dirty word, always to be
reduced, but as omnipresent. Moreover, the consequences of
stressors are viewed not as necessarily pathological but as quite
possibly salutary, contingent on the character of the stressor
and the successful resolution of tension. (5) In contradistinc-
tion to the search for magic-bullet solutions, we are urged to
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Toward aNew View of Health and Illness 13
D
tive hypotheses). I do think that the pathogenic orientation,
which underlies ' many advances in knowledge and practice, can-
E
not explain much of the data we have. Further, its near-total
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domination of our thinking has many limiting consequences.
Having thus taken an unequivocal position, I would make it
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look for magic bullets. My plea, rather, is that we see the two
O
presently exists.
If I were to sum up the most important consequence of
the salutogenic orientation in one sentence, I would say: Think-
ing salutogenically not only opens the way for, but compels us
to devote our energies to, the formulation and advance of a the-
ory of coping. Having adopted this orientation, I was led in due
course to formulating the concept of the sense of coherence as
the core of the answer to the salu togenic question. I am per-
suaded that this answer has merit. But, as in all of science, the
question is always more important than a given answer. It is to
my present understanding of the SOC concept and to other ele-
ments of the salutogenic model that I now tum.
Before doing so, however, I would clarify one matter. I
have earlier referred to my pessimistic bent. The underlying
premise of salu togenesis is indeed pessimistic, yet paradoxical-
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14 Unraveling the Mystery of Health
ly, the vista it opens up, though sans illusion, is far from dark.
It has been better put than I could have done, in a book by
Fries and Crapo (1981). Readers of Health, Stress, and Coping
may recall a reference to Oliver Wendell Holmes's "wonderful
one-hoss shay" (Antonovsky, 1979, p. 195). I had been tempted
to include all of the poem from which this is taken but decided
not to, mistakenly assuming that most of my readers recalled
the poem from their childhood schooldays. Fries and Crapo, I
was delighted to see, gave in to the temptation. Thus their very
serious biological study is suffused with a spirit much in accord
with salutogenesis. In brief, they argue that, despite the fixed
D
age span of the human organism, despite the "spontaneous
molecular degradations inherent in the finite rate of entropy
E
production in metabolizing systems" (p. 39) that underlie the
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inevitable processes of aging, a "rectangularization" of the hu-
man curve of survival is well under way. Thus, with appropriate
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tic reading of the data and am more sensitive than they to pos-
sibilities of reversals in the deCline in secular trends of morbid-
ity and mortality. What we share, I believe, is that if we keep
C
our eyes wide open to reality, the way is open to increasing our
understanding of coping. Their solutions are not mine. But
again, it is the question that is important.
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2
The "Sense of Coherence" Concept
•
If, in emphasizing the importance of the salutogenic question,
D
I have seemed diffident about my particular answer to the ques-
E
tion, this has been unintentional. I am quite persuaded, until
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data compel me to modify or change my position, that the
sense of coherence is a very major determinant of maintaining
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15
16 Unraveling the Mystery of Health
ponents, (3) the concept of boundaries, (4) the strong and the
rigid SOC, and (5) stressors as generalized resistance deficits.
D
Although the concept was tentatively satisfying, I did not
E
feel ready to operationalize it without further clarification. A
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seI."ies of in-depth, largely unstructured interviews with a wide
variety of persons, fifty-one in number, was initiated. All had
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The question that guided the interviews was how they saw their
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theme was so clearly identified. The second theme was at least
foreshadowed in the phrase "a high probability that things will
E
work out as well as can reasonably be expected" (1979, p .
IA HT
.123). Yet the emphasis remained cognitive, expressed in the
phrase "a solid capacity to judge reality" (p. 127), rather than
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never noted by the strong-SOC respondents, ' was that of the sad
O
sack, the shl£mazl (the one on whom the soup gets spilled), or,
in the occasional extreme version, a touch of paranoia. Things
C
sources of stressors and coping resources. Yet I have been amazed, in re-
cent years, that many seem to have forgotten that a man by the name of
Freud ever lived and that internal stimuli and conflict are omnipresent.
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18 Unraveling the Mystery of Health
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until the interview protocols were studied that the significance
E
of this component became apparent. I now see it as represent-
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ing the motivational element. Those classified as having a strong
SOC always spoke of areas of life that were important to them,
that they very much cared about, that "made sense" to them
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The "Sense of Coherence" Concept 19
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posed by these stimulz"; and (3) these demands are
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challenges, worthy of investment and engagement.
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Relations Among the Three Components
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eight possible types that emerge when we dichotomize each of
E
the three components (see Table 1). The two types (1 and 8)
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Table 1. Dynamic In~errelatedness of the SOC Components.
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Component
L
Comprehen- Manage- Meaning-
Type sibility ability fulness Prediction
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who are high or low on all three pose no problems. We can an-
ticipate that theirs is a quite stable pattern, viewing the world as
highly coherent or incoherent. But what of the other combina-
tions? Two others (2 and 7), I suggest, will rarely be found:
those that combine being low on comprehensibility and being
high on manageability. High manageability, it seems clear to
me, is strongly contingent on high comprehensibility. A require-
ment for the sense that resources are available to one to meet
demands is that one have a clear picture of what those demands
are. Living in a world one thinks is chaotic and unpredictable
makes it most difficult to think that one can manage well.
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The "Sense of Coherence" Concept 21
D
ble; nor is one impelled to search for resources. The notation
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for these two types would be as follows:
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High C + low MA + high ME--- high C + high MA + high ME .
High C + low MA + low ME • low C + low MA + low ME
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The centrality of meaningfulness is likewise seen in con-
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sidering the two final types. Even if one is high on both compre-
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and believing that the resources are at one's disposal to play suc-
cessfully, without caring (type 5) one soon comes to fall behind
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Boundaries
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Chapter 5 of Health, Stress, and Coping, by title and re-
peated reference, refers to the SOC as a "generalized, long-last-
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ing way of seeing the world and one's life in it." But in our
L
depth interviews, we found, over and over again, persons whom
we classified as having a strong SOC who did not see their entire
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much, is not of importance to us. For one person the scope may
be very broad; for another, relatively narrow. The boundary no-
tion suggests that one need not necessarily feel that all of life is
highly comprehensible, manageable, and meaningful in order to
have a strong SOC. Quite conceivably, people might feel that
they have little investment in national or international politics,
are tone-deaf with regard to art or religion, have little compe-
tence in manual or cognitive skills, little concern for local volun-
teer groups or trade union activity, and so on, and yet have a
strong SOC.
The crucial issue is whether there are spheres of life that
are of subjective importance to the person. If not, then, as sug-
gested by the discussion above on relations among the compo-
nen ts of the SOC, there is little likelihood of having a strong
SOC. If there are, then the question arises whether the person
sees these important areas as comprehensible, manageable, and
meaningful.
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The "Sense of Coherence" Concept 23
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are perceived as challenges worthy of the investment of energy.
E
It should be noted, with respect to one's major activity, that the
question is not necessarily one of intrinsic satisfaction (so often
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the focus of intellectuals). One can find little joy in one's work,
in keeping house, in going to school, or in being in the army.
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But if one is persuaded that the work has meaning because this
L
is how one supports one's loved family, cares for one's children,
R
cluding one's relation to the larger social order, does not mean
C
that the real world will not objectively influence one's life. The
most apolitical person in the world may be drafted, sent to war,
and killed. A lack of interest in whether one's community water
supply is fluoridated will not obviate the effect on one's chil-
dren's teeth. I have intentionally given these two examples that
refer to health consequences. No claim is made that the SOC is
the only variable that influences one's health.
There is one further implication of the boundary con-
cept to which I would call attention. Pearlin (1980, p. 185) dis-
cusses the possibility of relegating life areas to "a marginal place
in his life" as a way of avoiding distress. 2 Polanyi, in another
context, is cited by Gatlin (1972, p. 109) as referring to "the
2 Actually,
Pearlin's example refers to work. As indicated, I doubt
very much that anyone can so easily dismiss what one does for a major
part of one's waking hours. What one can do, as suggested, is give it a dif-
ferent meaning. If one fails to do so, one's SOC will be impaired.
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24 Unraveling the Mystery of Health
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retirement from work provides a fine example of the possibili-
E
ties of this two-way flexibility. The strong-SOC person, entering
retirement, can phase out his or her involvement in the realm
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of paid work while becoming engaged in new spheres such as
community action or esthetic expression.
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may well be the case, if one follows such people over time. But
at any ·given time, there are people who insist that just about
E
everything is comprehensible, manageable, and meaningful. The
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basic theoretical problem of distinguishing between strength
and rigidity is not solved by the mechanical solution of disre-
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garding the very high scorers. And it is the theoretical, not the
L
technical, problem which interests me. The first clue to a solu-
tion of the theoretical problem came from thinking about the
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data on the health status of groups like the Mormons (see, for
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most likely to have a strong rather than a rigid SOC. The an-
swers to new adaptive problems can always be fitted into the
old tried and tested framework. By contrast, the lonely individ-
ual, or the one attracted to a new, ephemeral gospel that gives
one a set of answers which seemingly solve the terrible anxiety
. of nothingness if only one clings tightly to the life raft, is likely
to be drowned by the perpetual waves of life .
. This line of thinking, in tum, led to a consideration of
Kohut's (1982) distinction between the sense of self and the
sense of identity (although Kohut does not use sense of).
Whereas the former refers to the basic layers of the personality
which provide a central purpose, a sense of abiding sameness
and continuity. identity refers to the social role complex of the
individual. A strong self makes possible a firm identity; but itis
not basically dependent on the explicit identity in which at any
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26 Unraveling the Mystery of Health
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with a weak self may, in frenzy, latch on to a given identity in
rigid fashion, seeking to allay the terrible anxieties that prey
E
on one precisely because the self is weak. Such a person would
IA HT
have a rigid SOC, whose substantive perceptions of high com-
prehensibility, manageability, and meaningfulness allow of no
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Some are hysterically rigid. But many others are calm, quite at
peace with themselves, even though they seem to have all the
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feedback, then indeed the true believer's SOC will be rigid, or
E
else the transfonnation will not be tolerated.
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Gatlin's work (1972), which led me to Koestler, con-
fronted the issue in terms particularly congenial to my own
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new books arrive, that is, when the environment changes, there
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val is the minimax solution of game theory (p. 110), that is, a
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GRRs, namely, that a GRR by definition creates life experi-
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ences characterized by consistency, participation in shaping out-
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come, and an .underload-overload balance and thus gives rise to
or reinforces a strong SOC, can also be applied to stressors. I
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phenomenon is a GRR; if toward the latter, a GRD. But in any
case, chronic resources or chronic stressors, built into the life
E
situation of the person, are generalized and long-lasting. They
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are the primary determinants of one's SOC level.
People also, however, experience major life events that
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are specifiable in time and space. These are the stressors that
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have, in the wake of the work of Holmes andRahe (1967), so
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30 Unraveling the Mystery of Health
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idiosyncratic, they may truly be disregarded, even though they
do require adaptation.
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Lazarus, who introduced the concept of daily hassles
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into stress research, seems ambivalent about the concept. On
the one hand, he tends to focus on the proximal, discrete event;
ER IG
ability. "
The methodological implication of this reconceptualiza-
tion is of considerable significance. The Holmes/Rahe Social Re-
adjustment Rating Scale, as well as the many versions that have
since been used, derived from a pathogenic orientation. Stressors
were assumed or hypothesized to be bad for the health. Others
limited this hypothesis to negative events, exits, or uncontrolled
or unexpected events. Common to all these approaches was the
failure to specify why this should be the case. In proposing the
salu togenic model, I focused on G RRs, as defined, which build
up a strong SOC, crucial to one's ability to manage tension well.
I grudgingly granted that one had to continue to measure
stressors but shared in the failure to specify why. Subsuming
stressors, and particularly chronic, endemic stressors, under the
overarching concept of GRR-RDs provides a theoretical basis
for constructing a measurement tool that links the resources
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The "Sense of Coherence" Concept 31
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mental description of many different environments. In a recent
E
study (Billings and Moos, 1982), they applied this approach to
the study of work environments. Their research was designed to
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"focus on the extent to which work and family resources atten-
uate the relationships between work stressors and individual ad-
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toward cohesion and independence as two of the most impor-
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tant social-environmental resources .... Conversely ... lack of
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emphasis on these factors is a significant source of stress."
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M P O
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3
Similarities of the Concept
to Other Views of Health
E D
My intellectual debts to many colleagues are clearly specified
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throughout Health, Stress, and Coping. Although my own re-
search over many years, at least in retrospect, showed a fairly
direct line that ultimately led to the salutogenic model, I could
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not have developed this model had I not leame~ much from
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· Selye, Dubos, Holmes and Rahe, Kohn, Cassel, and many oth-
·ers. Nonetheless, completing the book left me not only with a
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where. Thus, reading Erikson's "re-view of the completed life
E
cycle" (1982), I was surprised and pleased to encounter the fol- .
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lowing sentence in his discussion of integrity, which he sees as
the dominant syntonic trait in the last stage of life. "This in its
simplest meaning," he writes (pp. 64-65), "is, of course, a sense
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and in the Ethos, the threat of a sudden and nearly total loss of
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Hardiness
D
to her first two papers reporting her research. In January 1979
E
(thus she could not have read my book), I was delighted to find,
she had defined her problem clearly (Kobasa, 1979, p. 2): "The
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presence of subjects with high stress scores who are not getting
sick ... [has] been overlooked in the popular and professional
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Commitment
i :~
• I wonder why I work at all.
II!.
,
I,
"
• Most of lif@ is wasted in meaningless activity.
• The attempt to know yourself is a waste of effort.
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In one of her studies, however, a twelve-item scale was
constructed using items from the above alienation scales, from '
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a "vegetativeness versus vigorousness" scale (involving attitudes
like apathy, indifference, and aimlessness), and, unfortunately,
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Control
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Similarities of the Concept to Other Views of Health 37
D
• Thinking of yourself as a free person leads to great frustra-
E
tion and difficulty . .
• Most of my activities are determined by what society de-
IA HT
mands.
ER IG
hard he tries."
Kobasa's conceptualization and measurement of control
are solidly rooted in the very extensive locus-of-controllitera-
C
Challenge
D
study of lawyers (Kobasa, 1982a, p. 709), there is an implicit
linkage of the challenge component to the distinction between
E
transfonnational and regressive coping. The fonner refers to ex-
IA HT
ploiting the stressful situation as an opportunity for personal
growth.
ER IG
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Similarities of the Concept to Other Views of Health 39
D
posing an answer along the same lines.
E
Being a pediatrician, Boyce became interested in condi-
IA HT
tions that facilitated children's staying healthy. His medical
training led him to propose that "family routines may have a
biological, developmental foundation in an intrinsic human pre-
ER IG
sen and others, 1983, p. 202) is likely, Boyce and his colleagues
C
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40 Unraveling the Mystery of Health
D
In sum, Boyce, taking his departure from a biological
E
premise of rhythmicity integrated with the assumption of a hu-
man need for continuity, has developed a model that incorpo-
IA HT
rates three components: repetitive behaviors, valued elements
of life experience, and self-awareness as competent and relia-
ER IG
2This idea has also been suggested by Boyce, Schaefer, and Vitti
(1985, p. 1280), who write that "it is also plausible to hypothesize that
the health effects of both stressful events and social support might be ex-
plained in part by their tendency to either weaken or sustain a child's
sense of continuity or permanence."
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-
Similarities of the Concept to Other Views of Health 41
D
• Panel III includes both "stressful life circumstances" and
E
"social network resources" that affect, and are affected by
IA HT
(for, throughout his diagram, Moos includes not only direct
and indirect effects on the eventual outcome variable but
also feedback, reciprocal effects of one variable on another),
ER RIG
D
or goal orientation, dimensions are called autonomy, task orien-
E
tation, and work pressure. The four system maintenance and
IA HT
change dimensions are called clarity, control, innovation, and
physical comfort. 3
"Relationship dimensions," Moos writes, "assess the ex-
ER IG
ting is oriented." Whatever the , task may be, then, these are the
dimensions that relate to achieving it. "System maintenance and
C
D
environment. Or one could reasonably argue the opposite. Both
approaches merit study. 4
E
.
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44 Unraveling the Mystery of Health
D
respect to mental health and developmental functioning in chil-
E
dren, this is hardly the case in the area of physical health in
IA HT
adults. Having said this, I nonetheless feel it is important to
bring Werner and Smith's work to the attention of the reader,
in the context of my discussion of convergences.
ER IG
D
an informal, multiage network of kin, peers, ' and
E
elders who shared similar values and beliefs, and
IA HT
from whom the resilient youth sought counsel and
support in times of crises and major role transitions
ER IG
[po 156].
L
R
D
249). Subsequently, he again uses the word coherence, asking
E
whether the family assumes that there is "a knowable, struc-
IA HT
tural coherence underlying and explaining the experienced
world" (p. 209).
Unfortunately, Reiss does not make a clear distinction
ER IG
D
Reiss, then, describes what he calls the construction of
reality of the "environment-sensitive family" as high on config-
E
uration, high on delayed closure, and high on complex coordi-
IA HT
nation. It would take us too far afield to discuss Reiss's ingen-
ious and complex empirical work which led him to develop a
ER IG
Comparisons
C
E
I A HT
Sense of
Coherence Kobasa Boyce Moos Werner Reiss
Meaningfulness Commitment Relationship Coordination
ER IG
Self-involvemen t; Central valued ele- Cohesion, auton- . Network sharing A complex sharing
low alienation ments of life ex- omy, support values and beliefs process to develop
L
R
perience consensus
AT Y
M P System
Comprehensibility Challenge maintenance Configuration
Change is norma- Observable ,repe ti- Clarity, organiza- Structure and rules Order, organiza-
O
tive tive behaviors; tion, consistency tion, coherence
C
predictabili ty;
regularity
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-
Similarities of the Concept to Other Views of Health 49
D
which events that go on are viewed as challenges worthy of
E
commitment. Kobasa writes of commitment to self and vigor-
ous involvement in one's life. The four others, true, do not di-
IA HT
rectly refer to a person's orientation, to the way the world is
seen. However, in contrast to Kobasa, who has not considered
ER IG
all speak of the social climate, to use Moos's phrase, which pro-
AT Y
D
nence, in order to avoid the danger of frozen ritualization and
E
to allow for organic growth and for integration of life changes
IA HT
like marriage, birth of a child, the empty nest, and retirement
into one's scheme of things. Permanence, in other words, dis-
ER IG
5 For
a discussion of the consequences of frozen ritual, using the
example of elderly Jews conducting a Passover seder with children who no
longer care, see Antonovsky (1985 and 1986).
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-
Similarities of the Concept to Other Views of Health 51
D
the Security Scale, measuring the challenge component of hard-
E
iness, is of no predictive value to health, with some indication
IA HT
that the reverse may even be true (Kobasa, 1979; Kobasa, Mad-
di, and Courington, 1981). In personal correspondence, Kobasa
has noted her own sense of the inadequacy of the Security Scale
ER IG
ties ... and tum them into something 'coherent.' " If this is
indeed the case, then surely there is much more agreement be-
C
D
row scale posits only two alternatives: either I control matters
E
or someone or something "out there" does. It posits a funda-
men tal mistrust in power being in the hands of anyone else.
IA HT
Such a stance may be appropriate, unless carried to the para-
noid extreme, in the context of a culture based on individualism
ER IG
and free enterprise. But these are not the only two alternatives.
L
One may be very high on my manageability as well as on Ko-
R
D
others and "thus promote vicarious secondary control ... in
E
order to enhance one's sense of strength or power." They also
write of "finding reasons and purpose in events that cannot be
IA HT
altered." (All excerpts are from pp. 955-956.) In this paper, and
the two comments by Japanese researchers that follow, the dis-
ER IG
culture-bound.
I had completed writing this discussion of convergences
when my attention was brought to an empirical study of thirty
-families, conducted by Oliveri and Reiss (1984), in which they
used Moos's Family Environment Scale and Reiss's Card Sort
Procedure. On theoretical grounds, the authors anticipate asso-
ciation between the two sets of dimensions measured. Thus
they write(p. 37):
D
be expected to be inversely associated with con-
E
trol and moral-religious emphasis, since these FES
IA HT
dimensions are plausible indicators of the rigidity
and dependence on tradition attributed to early-
ER IG
closure factors.
L
R
Partial Affinities
D
ginning to change. By the time of the second compilation by
Dohrenwend and Dohrenwend (1981), a very significant shift in
E
emphasis had taken place, expressed most succinctly in the
IA HT
word med£ators. Rabkin and Struening's paper (1976), appear-
ing in Sc£ence, gave prominence to the word. Two maj or streams
ER IG
-whom one might even call Mr. Coping, considering his seminal
AT Y
contributions from the early sixties till this day-more and more
M OP
D
further analyze the Midtown data, he sought to understand the
E
pathogenically oriented finding that 47.3 percent of the true
poverty stratum was in the Impaired category of mental health
IA HT
classification. Then came the shift in attention to "those who
are deviant in the specific sense that they have come through
ER IG
cally intact" (p. 135), Srole asked. Calling on his personal and
M OP
D
on the relationship between mental and physical illness. But for
E
my purposes, the chief lesson is reported in a brief paper (Vail-
lant, 1979). Here his focus is on a subgroup of ninety-five
IA HT
healthy young men, about whom he writes: "I have been im-
pressed with how little effect stress per se has had upon their
ER RIG
lives" (p. 732). Seeking to explain not only survival but excel-
L
lent health well into the fifties, Vaillant hypothesizes that the
dominant mode of defense mechanism manifested in adulthood
AT Y
D
In two earlier studies on samples of 45 and 127 from the
E
original cohort (Betz and Thomas, 1979), the focus was on
IA HT
specifying the methods for classifying respondents into the
Alpha, Beta, and Gamma temperament types on the basis of
data collected during the medical school years. Results point to
ER IG
D
"
E
behavior will indeed lead to that outcome (that is, comprehensi-
IA HT
bility); and third, the belief that one can successfully perform
that behavior (that is, manageability).
ER IG
D
client; be sensitive to the client's personal or cultural style, for
E
example, exerting control versus a sense of subjective serenity;
IA HT
define the problem as a challenge; create a sense of curiosity
and adventure. These are hints; the discussion of conceptualiza-
tion is even more analogous to the soc. Meichenbaum and
ER IG
cope (p. 28). Finally, they stress that "throughout, clients ...
[should] collaborate in the generation of this reconceptualiza-
tion" (p. 29). Though applied to a therapeutic situation con-
fronting a concrete problem, the conceptualization stage, at
least implicitly, is aimed at strengthening the sense of compre-
hensibility, manageability, and meaningfulness of the client.
Finally, we tum briefly to the work of Shalit (1982). En-
gaged in an extensive series of studies in Sweden, concerned
largely with effective performance in the military, Shalit has ex-
ploited, refined, and extended Lazarus's work on coping in
terms highly compatible with the SOC model. His AIM (Ap-
praisal Integration Model) takes as its point of departure "the
concept that the more coherent a picture an individual can at-
tain of his situation or enviro~ment, the better his potential for
acting on or interacting with this environment" (p. 4). The ap-
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Similarities of the Concept to Other Views of Health 61
D
behavior in concrete situations, he goes on to speak of a final
E
"status appraisal" relevant to the particular situation and re-
IA HT
appraisal following an adaptive response. I t is, however, the first
three stages that concern us here. Clearly, they are parallel to
ER IG
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62 Unraveling the Mystery of Health
D
jor reference group. Yet, despite the fact that medical sociology
E
in Europe and America is a leading subdiscipline, I have not
been able to include reference in this chapter to the work of
IA HT
any sociologist except an early paper by Srole. I think this un-
fortunate, for surely a sociological perspective can add greatly
ER IG
;I
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4
Measuring the Concept:
A New Scale
D
herence," I wrote (1979, p. 156). As one whose life has been
E
rooted in two different cultures, whose research has focused on
IA HT
class and ethnic subcultures, and who has traveled extensively,
I have tried to avoid the trap of thinking the world is well rep-
resented by a sample of American university students in Psy-
ER IG
chology 101. In much the same way, I am fully aware that there
L
R
63
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64 Unraveling the Mystery of Health
D
It cannot be said that, once Health, Stress, and Copz'ng
E
was completed, the SOC was only a vague intuitive notion. It
IA HT
had been explicitly defined (p. 123) and the definition discussed
at length. Conceptual clarification, nonetheless, is not easily
ER RIG
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;::::
D
gamu t was covered, ranging from unemployment and manual
E
labor through senior officials and professionals (and eight
housewives). Of the fifty-one, however, it is of interest that no
IA HT
fewer than fifteen were at higher-level administrative and pro-
fessional jobs- a hint about who our referees thought were high-
ER RIG
which conveyed our interest in how people had coped with dif-
M P
and I are indebted to the more than twenty referees and, above all, to the
respondents. Each of their life histories provided a moving experience
for us.
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66 Unraveling the Mystery of Health
D
agreement was found with respect to seven (15 percent) of the
protocols.
E
IA HT
As a first result of an empirical venture at testing whether
the SOC concept had consensual validity, these results did not
ER IG
seem bad. But the goal of the pilot study was precisely to im-
prove the basis for such validity. The next step was to review, in
L
R
great detail, the protocols of the sixteen persons who had been
AT Y
opposite end. My search was for elements in the way one looked
at life that were common in the former group but absent in the
latter, and vice versa. Over and over again, a number of phrases,
C
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..
Measuring the Concept: A New Scale 67
D
su rv£v or)
E
[Referring to historic events of World War
IA HT
II] While these events for me are living memories,
they didn't, as it were, refer to me specifically. I
had no sense of personal affront. What happened,
ER IG
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68 Unraveling the Mystery of Health
D
doesn't have to be God. It can be another force,
E
but you have to have faith. Otherwise you can't
IA HT
suffer so much and go on.... How can your health
be when you're so old? But I have no complaints.
· .. I don't see so well, I can't read, that's what
ER IG
work.
M OP
D
joyed being at home, although I also kept on
E
studying special teaching techniques .... What real-
IA HT
ly gave me a push ... I began to see how important
community activities were, especially nursery
schools for working mothers .... It involved me
ER IG
D
compliments, always got along well and did well
E
... sometimes, when I'm alone, I think about my-
self, think how I can't do anything without the
IA HT
prosthesis, but with it I can do everything.... I
always had a strong will, never felt that there was
ER IG
D
things will be good.... I never despair. ... I have
E
nothing to complain about. It's all a matter of will.
IA HT
... I'm only sorry I'm not yet married.... What I
can do, I do; what I can't, well ... You have to
ER IG
D
when my husband died .... They tossed him out
E
of the hospital, as if there was nothing wrong. But
I knew from his looks that he was sick. ... I be-
IA HT
lieve in fate. True, I don't know who runs it, be-
cause I don't believe in God anymore .... I couldn't
ER IG
D
a ball that the higher-ups play with.
E
Respondent 30 (male, 44, M+4, labor-
IA HT
er, dz"srupted chZ"ldhood jamz"ly, com-
bat breakdown)
ER IG
D
[After World War II] I married the first Jew-
E
ish man I met. We belonged to two different
IA HT
worlds; our marriage was never a success .... I
brought a child into the world ... devoted my life
to her ... terrible guil t feelings ... a constant
ER IG
D
techniques, such as item-total score correlations or factor analy-
E
sis, that clarified dimensionality and indicated which items did
IA HT
or did not belong to what was to be used as an index. Perusal
of many indexes, such as Rotter's Internal-External Locus of
ER IG
the item were held constant- the time period, for example
C
D
The first has a cognitive emphasis absent in the second. These
differences are not systematically varied throughout the ques-
E
tionnaire but are simply given no thought. We know enough
IA HT
about questionnaire construction to know that every word in-
cluded, not only a key word or the general sense of the item,
ER IG
The tool that allows one to do so, facet design, was de-
AT Y
element in each facet and provides the basis for the formulation
of a given item. A mapping sentence, presenting the facets and
elements, formally subsumes in succinct fashion the entire po-
tential for questionnaire items (see Figure 1).
In the present case, it was clear that the first facet to be
considered was the SOC (the response mode), with its three
components of comprehensibility, manageability, and meaning-
fulness. Every item would be limited to expressing one of these
components (or, technically, elements). This facet, thus, is the
response mode of the respondent to a given stimulus. In other
words, a questionnaire item would ask: To what extent do you
perceive stimulus X as comprehensible? (For example: How
often do you find that you don't understand what other people
are saying to you?) A second item would ask: To what extent
do you perceive stimulus X as meaningful? (For example: How
This copy is intended for use of the recipient only, whose name is encrypted in the file.
?
A. Modality
I. ins trumen tal }
Respondent X responds to a{n) 2. cognitive stimulus
{ 3. affective
B. Source
1. the in ternal }
which has originated from 2. the external environment{s)
{ 3. both
C. Demand (subject)
I. concrete }
and which poses a{n) 2. diffuse demand, the stimulus
D
{ 3. abstract
E D. Time
IA HT
1. past
being in the 2. present } in response dimension
{
3. future
ER RIG
E. SOC components
L
1. comprehensibility high
2. manageability } in terms of Facet E.
AT Y
{
3. meaningfulness low
M PO
often do you find that you don't care about what other people
C
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78 Unraveling the Mystery of Health
D
those with a strong character-sometimes feel like sad sacks
E
(losers) in certain situations. How often have you felt this way
IA HT
in the past?" (response range from "never" to "very often").
This item is defined as a manageability item, with profile A3,
ER IG
and forty items would provide a good, feasible basis for an in-
dex of the SOC. Some items were dropped because they repre-
sented duplicates of the same profile. Perusal of the mapping
sentence generated some new items. At the end of this process,
I had thirty-six items, each representing a different profile-
that is, a wide range of stimuli-and was ready to pretest.
3 This
item was chosen as an example not only because it refers to
one of the most striking themes noted in the pilot study and because data
analysis showed it to be one of the strongest items but also because it
exemplifies a problem in constructing an instrument designed to be useful
cross~cu1turally. The questionnaire was originally designed in Hebrew,
which has a word (misken) that conveys perfectly what was meant. In
translating it in to English, my native language, I forgot that my English
was of World .War II vintage, when "sad sack" was a type familiar to most
Americans. "Loser" may be the best contemporary equivalent. It refers
to the fellow to whom unfortunate things happen, the shlimazl, on whom
the shlimihl spills the soup.
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...
Measuring the Concept: A New Scale 79
D
Psychometric Properties
E
The twenty-nine-item SOC questionnaire appeared in
IA HT
print in Antonovsky (1983). It was first field-tested, in Hebrew,
with an Israeli national sample and has since been used by me
ER RIG
AT Y
M OP Standard Coefficient Cronbach's
Population N Range a Mean Deviation of Variation Alpha Date
Isr~eli
national sample 297 90-189 136.47 19.82 .145 .837 1982
C
New York State production workers 111 62-189 133.01 26.45 .199 .933 1985
U.S. undergraduates- I 336 63-176 133.13 20.09 .151 .881 1983
U.S. psychology major undergraduates 59 139.71 20.86 .149 1984
U.S. undergraduates-II 308 132.40 21.96 .166 .879 1985
Israeli army officer trainees- I 117 98-196 158.65 17.02 .107 .882 1985
Israeli army officer trainees- II 338 90-199 160.44 1p.69 .104 .880 1985
Israeli army officer trainees-III 228 109-203 158.99 17.19 .108 .891 1985
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Israeli heal th workers 33 116-190 151.42 17.50 .116 .910 1983
,
Edmonton health workers 108 101-192 148.63 17.15 .115 .881 1983
Nordic occupational health workers 30 95-187 146.10 19.90 .136 1985
Note: The present version of the questionnaire, used in the 1985 studies, has a slightly different ordering of the items
than that used in the earlier studies. There had been an indication that a concentration of several similar items might raise scores
sligh tly. These were dispersed.
The two dashed lines are intended to differentiate among (1) the homogeneous army groups; (2) the homogeneous health
D
workers; (3) diverse populations.
E
a The theoretical range on the twenty-nine item, seven-point semantic differential questionnaire is 29-203.
I A HT
ER IG
L
R
AT Y
M P O
C
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82 Unraveling the Mystery of Health
D
the instrumen t.
E
Many years ago, in a paper which I believe appeared in
IA HT
the American Psychologist but which I have been unable to lo-
cate, the author defined face and content validity in terms of
ER RIG
struction. I should here add that, before going out into the
M P
field, I asked four colleagues to go ' over each item and, first,
O
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Measuring the Concept: A New Scale 83
D
undergraduates. He also included two other instruments. The
alphas of the two scales were .903 and .881, respectively (com-
E
pared, it migh t be noted, with. 706 of Rotter's very widely used
IA HT
In temal-Ex ternal Locus of Control Scale). The correlation be-
tween the two SOC scales is .639, a most respectable indication
ER IG
ity.)
O
The data from the same study also allow tests of conver-
gent and discriminant validity. In the middle-class American cul-
C
D
Further evidence of the validity of the SOC scale is found
in the data in Table 3.A valid scale should produce differences
E
on mean scores among samples that would be expected to differ
IA HT
(the known-groups technique).' The highest mean scores among
the various samples are found in the three groups of Israeli army
ER IG
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Measuring the Concept: A New Scale 85
D
psychology undergraduates, using a battery of other measures
to test its validity. They found a correlation of .72 between the
E
SOC scale and Rumbaut's twenty-two-item SOC. The correla-
IA HT
tion between the SOC scal_e and a forty-item scale designed to
measure SOC which had been independently developed in 1981
ER RIG
(Payne, 1982), with which I had not been very happy, was sig-
nificant but much lower (.39). Of more importance, the au-
L
thors' analyses of the relations between the SOC scale and a
AT Y
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86 Unraveling the Mystery of Health
D
sentation of the SOC construct. We do have, I believe, a tool
that, for those who think the salu togenichypothesis makes the-
E
oretical sense, can be used. The scale will undoubtedly undergo
IA HT
modification in the future. But for the time being, it is ready
to go . .
ER IG
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Measuring the Concept: A New Scale 87
D
component and its construct equivalent were indeed significant.
However, they found that each of the components was just as
E
related to the other construct equivalents as was the SOC com-
IA HT
ponent supposedly closest. "These construct measures," they
write, "did not distinguish among Antonovsky subscales" (p. 2).
ER IG
then, that the present version of the SOC scale is not wisely
used to study component interrelations. This question remains
on the agenda of unfinished business.
D
naire is only one road to follow.
E
IA HT
ER IG
L
R
AT Y
M PO
C
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--
! I
I
."
,
5
How the Sense of Coherence
Develops over the Lifespan "
D
Life Experiences and Their Contexts
E
IA HT
In Health, Stress, and Copz"ng (1979, p. 80), I had made use of
Galdston's (1954, p. 13) metaphor to illustrate the ubiquity of
ER IG
balance and recover it; or slip, catch the rope, and return to a
_standing position; or fall into a net and again regain the rope; or
C
89
90 Unraveling the Mystery of Health
D
than those who practiced none of them" (quoted in Matarazzo,
E
1984, p. 17). McKeown (1979), one of the first to bring the
IA HT
life-style issue forcefully to world attention, had been more
sophisticated. He at least implied that life-styles derived from
ER IG
tends to assume · that people are jumping into the river of their
own volition and refusing to learn t6 swim.
O
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----
How the Sense of Coherence Develops over the Lifespan 91
D
Health, Stress, and Copz"ng to going beyond the in trafamily,
E
personality-shaping experiences; I related the SOC explicitly
IA HT
to social class and to societal and historical conditions, which,
in determining the generalized resistance resources available to
ER IG
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92 Unraveling the Mystery of Health
D
wake, the three components of the SOC clarified was a fuller
E
understanding of the nat:ure of the life experiences that lead to
IA HT
the SOC developed. The intuitive identification of the above
three characteristics had been on the right track. Now we can
ER IG
not of our own making or choosing in any way. For any life ex-
C
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How the Sense of Coherence Develops over the Lifespan 93
D
text is overload. It took me some time to realize that if partici-
pation in decision making is to lead to meaningfulness, it must
E
be in activity that is socially valued. The housewife's role is cen-
IA HT
tral to her ego identity. She may have an interest in art and
come to say that it is not really important to her. Bu t she can-
ER IG
en ter the role (and often it is not a matter of choice), the mes-
M P
sage is clearly conveyed to her that what she does is not particu-
O
D
salem, despite the vast cultural differences. But they differ
greatly in London's Kensington and ] ohannesburg's Soweto.
E
The life experiences, then, must be considered on a fairly high
IA HT
level of abstraction.
ER IG
text and you will find phrases like "the infant becomes progres-
..
' sively aware," "the child discovers and comes to comprehend,"
"the mother lives through, and loves with, her breasts." At best,
this description of "reality" is qualified by "this is what normal-
ly happens," with great surprise, expressive of a pathogenic ori-
entation, when it does not happen. It is to Erikson's great credit
that throughout his work he has taken pains to write of crisis
and challenge, of "a succession of potentialities" (1959, p. 52).
The crucial question is always the extent to which something
happens and its consequences ..
I make this point here in order to stress that, in concrete
D
reality, one cannot take the life experiences of consistency, load
balance, and participation for granted. In fact, I tend to think it
E
somewhat of a miracle when they are indeed on a high level.
IA HT
Take the idyllic picture of the well-to-do mother, delightedly
devoted to finding her full expression in caring for her baby,
ER IG
never has a fight with her husband, feels a lump in her breast, is
AT Y
. infonned that her father has had a heart attack, or finds her
M P
purse snatched while walking with the baby in the park. And, of
O
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96 Unraveling the Mystery of Health
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on not to be constantly changing. The variety of stimuli, from
within and without, may become familiar and routinized, as
E
may happen with responses. To the extent that this happens,
IA HT
the first picture of the world begins to become comprehensi-
ble. At this point, again, a warning must be issued not to fall
ER IG
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How the Sense of Coherence Develops over the Lifespan 97
D
come is contingent on the infant and child's actions, it can rea-
E
sonably be said that early on there is participation in decision
making. The crux of the matter is whether the quality of the re-
IA HT
sponse is embedded in positive affect. Coldness, hostility, and
disregard, even when obvious physiological needs are met, con-
ER IG
to us.
AT Y
D
world" (p. 489). In other words, sex roles enable us to feel that
we are competent. This applies to all our other social roles as
well.
E
IA HT
Condry's basic mode of thinking, as noted above, begs
the crucial question. "We develop both ways of perceiving the
ER RIG
world and thinking about the world which are accurate and effi-
L
cient, and we develop skilled patterns of interaction with the
world, which we are able to use in order to carry out our inten-
AT Y
tions" (p. 490). Some children are more successful in doing this,
M P
some less so. The issue is precisely what are the experiences that
O
D
forced. In either case, the "decision" has been the child's. Other
things are prohibited and punished, a clear message that not all
E
in the world is manageable. But if these two responses to what
IA HT
the child wills to do in response to demands from his inner envi-
ronment are relatively minor, and the large part of the picture
ER RIG
is either channelization (this way yes, that way no; now no, but
L
later yes) or encouragement (providing a double reward of en-
joyment in the activity and approval from significant others),
AT Y
that mattered were what the social world proposes to and de-
mands of the child. Kohn's work on parental values and child-
rearing patterns (1977), to which I referred at length in Health,
Stress, and Cop£ng (1979, pp. 142-147), links the two sides of
the coin. Parents who have "an orientation that is one of com-
plexity and flexibility, alternatives and self-direction, meaning,
consistency, choice, and a sense that problems are manageable
and solvable" (p. 147) are likely to respond to the things the
child wills to do in the mode of the previous paragraph. At the
same time, they are more likely to propose and to demand be-
haviors that neither underload nor overload the child. The like-
lihood is small that the child will be left totally to his or her
own devices, the essence of underload for a child. If anything,
the error will be in the direction of overload, of setting too
rapid a pace for demanded development. Such parents will in-
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100 Unraveling the Mystery of Health
D
corrective. In most cultures, the infant has one major caretaker
E
and shaper of the experiences that begin to mold the SOC, al-
though other less or more shadowy figures may be involved.
IA HT
Starting in early childhood, and increasing rapidly with age, the
child is exposed to a broader social environment. As Condry
ER RIG
peers, the school, and the television set." In one of the earliest
O
agent upon its members and takes over "the values of the cul-
ture in which they are being reared and uses these actively in
setting standards for each other's behavior" (p. 123). In this cul-
tural setting, we may expect relative consistency in the messages
sent to children, determined jointly by parents, caretakers, and
the group of toddlers. When Faigin studied kibbutz children,
there were no TV sets, and trips to the city were rare occa-
sions. This world has changed, and even in the kibbutz the mes-
sages to the child have become more complex. How much more,
then, in the world Condry describes! But complexity itself is not
the issue, and it may even be advantageous, for it opens greater
opportunities for balanced-load challenges and for participa-
tory, valued experiences. The problem it poses is, above all, that
of consistency. When parents reward (or punish) one kind of be-
havior, teachers another, playmates a third, and the mass media
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How the Sense of Coherence Develops over the Lifespan 101
Adolescence
D
childhood for a strong SOC will be upset in adolescence. One is
E
always too tall or too short, too fat or too thin, too dumb or
IA HT
too smart, with no breasts or too big breasts, too confined or
too free to walk the streets of the city, too young to do this
and too ( .d to do that, gawky, acned, and confused. If mes-
ER IG
how mucI-: more is this so for the adolescent! Yet this is not in-
herently necessary in human culture.
AT Y
D
in the Israeli kibbutz, as well as in a Western middle-class sub-
E
urb. The crucial question is the extent to which the cultural
IA HT
context and the social-structural reality impede or facilitate the
life experiences we have been discussing.
At the risk of oversimplification, three major cultural
ER RIG
the pivotal gender role, which may be taken as a proxy for the
totality of social roles through which the adolescent is called on
to express identity and elaborate an image of the world: "ob-
seIVing what is available in the culture, organizing and making
sense of this information, and coming to understand where hel
she fits in the scheme." Each of the three cultural paths offers a
differen t information complex. I
Life is never easy and painless, even for the most fortu-
nate of adolescents. But consider the boy who has grown up in
a childhood of age-graded continuity in a pleasant upper-mid- I
dle-class suburb of New York (or its equivalent in Sweden,
Japan, or Israel). A wide variety of challenging legitimate op-
i
tions are consistently presented to him by sophisticated parents,
peers, teachers, and the mass media. His experiments with mari-
juana, sex play, and career crazes are smilingly and tolerantly
criticized. He goes on to Reed College, takes a year off to wan-
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--,-
How the Sense of Coherence Develops over the Lifespan 103
D
Social class, history, and sex, as well as genes and idio-
E
syncratic fortune, have here combined to foster an emergent
IA HT
strong SOC. The information and choices offered by the envi-
ronment were always clear and realistic. The interplay between
individual proclivities and the choices tentatively made was al-
ER IG
that his father was not his biological father; that his homosexual
urges were totally unacceptable even in his liberal family; that
C
D
emotional expression tempered by the prohibition of physical
E
aggression, the information network in the community, the de-
IA HT
ferred gratification pattern, the mobilization of family resources
for the children, the experience of struggle to become self-
reliant-all these were protective against the paralyzing depen-
ER IG
em societies, may even take full part in them on one level, but
C
D
one's world as comprehensible, manageable, and meaningful.
For a large number .of the world's adolescents, however,
E
whether in central Aftica, central Europe, or the American Mid-
IA HT
west, life is a constant reminder of a world that is alien, hostile,
incomprehensible, and absurd. The core of adolescence for
ER IG
ger and cold and pain are bad enough in themselves. But the
AT Y
that there are many who are well fed and well clothed and have
never seen a rat in their lives. Schools convey the message that
Horatio Alger is still possible, but these adolescents know the
C
D
most direly in need of simplistic, clear-cut answers, it is particu-
E
larly gennane to adolescence.
IA HT
Does it work? Does it reinforce the basic layer of an SOC
set down in childhood or, for those whose childhood was want-
ing in this respect, allow reconstruction? With all my instincts
ER IG
and values, I would like to say no. I would like to say that the
L
R
must grant that the evidence is not at all clear. The experiences
M OP
Adulthood
D
ing hours for the next forty or so years. Anticipatory socializa-
E
tion has been completed and one is on one's own, in a particular
IA HT
culture and society. It is in the period of early adulthood, I be-
lieve, that one's location on the SOC continuum becomes more
or less fixed. I shall deal with the question of the dynamics of
ER IG
the SOC below. For the time being, let us explore its formation
L
in young adulthood.
R
woman has known that her destined role is that of wife and
mother. Through attachment and identification, she has had the
chance to acquire the great variety of skills needed to perform
this role well. Moreover, she has learned early on that not only
does her culture value this role highly, but it is regarded as the
cornerstone of the society. To the extent that she has been cared
for well, she has become capable of caring for others. She marries
and begins to have children and to make a home. What is her daily
life like, in terms of the life experiences of consistency, load
balance, and participation in socially valued decision making?
By and large, there is a great deal of consistency and pre-
dictability in her life. There are the mysterious illnesses of chil-
dren and the perpetual anxiety about accidents, the tempers of
the neighbors, and the moods of her husband when he returns
from work, but these become part of a familiar ebb and flow.
Moreover, within her domain, it is she who sets tempo, changes
the order
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the recipient toencrypted
only, whose name is allow breathing
in the file. space.
108 Unraveling the Mystery of Health
D
sense of burden is mitigated often by the knowledge that if
E
there were the time and energy to do everything, one could
IA HT
manage well. One does one's best. We must not, however, ig-
nore the problem of underload. This comes into being when
one's life is so structured that one's skills, abilities, interests,
ER IG
have never spent a day caring for a child or cooking for a fam-
ily, it may be hard to realize what talents are needed to do them
AT Y
of frustrated potential.
I t bears repeating that, in many cultures, the role of the
housewife, moreover, does indeed provide life experiences char-
acterized by participation in socially valued decision making.
Husband and wife, jointly or autonomously, in different but
equally valued areas, have acknowledged power and authority.
The way the home is run and the children are brought up is so-
cially regarded as no less important than extrafamily activities.
Superior physical strength is valued no more, or even less, than
superior emotional stamina. I have no illusions, as Illich (1985)
seems to have in his image of husband and wife in all non-West-
ern cultures as intertwined hands, that the housewife role al-
ways makes for a strong SOC. Living in the reality of the Mid-
dle East, I could hardly think this to be the case. My concern
here has been to delineate one particular pattern of life experi-
ences that can provide a strong SOC. For those skeptical about
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How the Sense of Coherence Develops over the Lifespan 109
D
SOC, doubly so because she most often works in a disvalued
E
female job. When to the social disvaluation of the housewife
role is added, as is frequently the case, economic dependence of
IA HT
the housewife on her husband, the application of superior phys-
ical strength, the cultural definition of the woman as serving the
ER IG
standing of how one's job shapes one's SOC. One must specify
the particular aspects of the job that are pertinent.
Eu t before turning to a detailed analysis, one crucial issue
must be raised at the outset. One need not be a Marxist to be-
come painfully aware that, almost without exception, the litera-
ture on occupational stress deals with the immediate objective
jo b conditions and subjective perception of these, with complete
disregard of the historical and broader social-structural situation
in which one's work is embedded. Conceivably, we can come to
understand the sense ,of manageability by studying only the im-
mediate work process; this is difficult with respect to comprehen-
D
sibility and virtually impossible with respect to meaningfulness.
E
Hoiberg (1982) analyzed the data on occupational stress
and hospitalization rates of U.S. Navy enlisted men over a
IA HT
thirty-year period without any mention that the period covered
included the Vietnam war. As one who took part in World War
ER IG
II, which we defined as a just war, and as one familiar with the
L
pioneering enterprise of Israeli kibbutzim transforming a desert
R
Does work have the same meaning for and impact on the person
who is engaged all his or her working hours in writing jingles to
advertise soap as it would for the same person, in the same
working conditions, writing children's books? Does it make any
difference whether a computer specialist works in a cancer re-
search center or in a nuclear facility? Or a floor cleaner in a hos-
pital or an office building?
I do not know the answer, although I am quite sure that
for at least a relatively brief period of years, involvement in
enterprises culturally valued or regarded as heroic does weigh
more heavily than specific work conditions. I stress this from a
salutogenic point of view. That is, if the grand enterprise is in-
deed grand, we exploit its meaning, if only to give us the energy
to bear with the not necessarily happy details. If the enterprise
in which we are engaged is not grand, we tend to forget the broad-
er picture, and the details of work conditions become all-impor-
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How the Sense of Coherence Develops over the Lifespan III
D
be a sense that "it is mine," that "I wish to do what I am
doing." What determines joy and pride? Intellectuals, writing
E
about work, tend to see self-expression as the central issue. With-
IA HT
out disregarding its importance, I suggest that for most workers
social valuation, on two levels, is of greater significance. First is
ER RIG
D
cisive in determining the sense of manageability. The issue of
E
control has been raised above, but it is also linked to manage-
IA HT
ability. The more I myself, or legitimate (in my eyes) others, set
problems before me, the more likely am I to feel that I have the
resources to solve them. But whoever sets the problems before
ER IG
D
material, social, and organizational resources at his or her dis-
E
posal, and which provide occasional overload as well as occa-
IA HT
sional opportunity for withdrawal and conservation of energy,
will strengthen the sense of manageability. But there is the
ER RIG
When our work experiences are continually such that we are sel-
dom called on to exercise our abilities or to actualize our poten-
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114 Unraveling the Mystery of Health
D
mation of the region's health care system Ilnks me to the broad-
er social structure. The en tire work experience fits together in a
E
picture that makes sense to me. Contrast this with Charlie Chap-
IA HT
lin in Modern T£mes, performing one operation on the produc-
tion line without the slightest notion of the product he presum-
ER IG
ture would flow from present. Not only was my own role clear;
the roles of others, and how they linked to mine, were equally
clear. If so complex a structure facilitated the experience of
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How the Sense of Coherence Develops over the Lifespan 115
D
order and cleanliness. In her theoretical paper, she develops the
E
concept of structured role complexity (which is the counterpart
IA HT
to Kohn's concept of substantive job complexity). Familiarity
with other roles in the context, with alternative solutions to
ER RIG
problems, with the overall goals, with planning- these and other
elements that derive from occupying a certain kind of role-set
L
complex at work facilitate having a comprehensible picture of
AT Y
one's world. Again, one must add the caveat of the danger of I;
overcomplexity and chaos.
M P
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116 Unraveling the Mystery of Health
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tive expectations, the ambience will be one of consistency. In
E
such a setting, one will time and again experience appropriate
IA HT
feedback. One sends signals, knowing they will be understood,
as will the signals sent to one. Symbols are shared; there is a
ER IG
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How the Sense of Coherence Develops over the Lifespan 11 7
D
his research program, raises an issue that is germane at this
poin t. "There is accumulating evidence," he writes, "that job
E
conditions affect adult personality mainly through a direct pro-
IA HT
cess of learning and generalization .... In short, the lessons of
work are directly carried over to nonoccupational realms ...
ER IG
work, I have implied that it is. Yet one major qualification must
be made. In addition to one's major activity role, one occupies
other major social roles. One is a won1an, a citizen, a TV view-
er, a member of a kinship network, a member of a natipnal .
group, a member of an ethnic or racial group. Further, one lives
in a given sociophysical environment. Each of these implies a
set of life experiences relevant to the SOC. (For a fascinating
analysis of the impact of the physical environment on personal-
ity, see Little, forthcoming, especially pt. 4, "Meaning, Struc-
ture, and Community as Core Dimensions," in which he dis-
cusses the SOC.) For some, these experiences may transcend
the major activity role in having an impact on the SOC.
No "problem" arises, of course, when the experiences in
other spheres of life are consistent with those in work life. Even
when there is no generalization from work life to other spheres,
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118 Unraveling the Mystery of Health
D
one's life is still shaped by the nonwork role.
E
But surely we must acknowledge the possibility that for
some, the drama · of consistency, load balance, and participa-
IA HT
tion in socially valued decision making in nonwork life be-
comes all-important, and work life pales into relatively minor
ER IG
industrial society and the work ethic becomes less central; this
M P
D
weakened by experiences in others. Pearlin (1980, p. 186) re-
coun ts the story of the woman whose husband frequently
E
drinks to excess and abuses her. But "she pays no attention to
IA HT
it, for in the things that really matter- being a steady worker
and a good earner- he is a prince." Pearlin, however, disregards
ER RIG
the likely dynamics. The woman's life becomes more and more
L
hellish, as her husband's drinking becomes chronic alcoholism,
he loses his job, and she sinks into apathy. Or, alternatively, she
AT Y
slams the door in his face and, with pain and courage, rebuilds
M P
her life. (See Woody Allen's Purple Rose of Ca£ro for the sad,
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120 Unraveling the Mystery of Health
D
rent time of life and that provides a basis on which further de-
E
velopment can occur in subsequent periods" (p. 289). In other
words, in even the smoothest of lives, adulthood is constantly
IA HT
complex and dynamic.
I could not agree more. Levinson focuses on the normal
ER RIG
so on- that happen "on time." But in the lives of all of us there
M P
are also major changes of the kind that Parkes (1971, p. 103)
O
space which are lasting in their effects, which take place over a
relatively short period of time, and which affect large areas of
the assumptive world." The examples he gives: loss of a job,
being blinded in an accident, premature death of a loved per-
son, housing relocation in an urban slum-clearing project. Hav-
ing devoted all of chapter 3 in Health, Stress, and Cop£ng to a
catalogue of stressors inherent in human existence, on what
grounds did I expect the SOC to be fairly stable throughout
adulthood?
What is now clear to me, as it was not in 1978, is that in
formulating the stability hypothesis, I had in mind the person
with a strong SOC. In Chapter Six I will discuss the SOC as an
independent variable, analyzing the pathways through which it
affects one's health. This discussion must be briefly anticipated
here. The issue can perhaps best be put in terms of the mainte-
nance of balance at a low level of entropy, of disorder, by the
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How the Sense of Coherence Develops over the Lifespan 121
open system that is the human organism. Entropic forces are in-
deed constantly and powerfully at work in the lives of all hu-
man beings. One's SOC is constantly and inevitably · being at-
tacked. But what characterizes the person who has, in early
adulthood, crystallized a strong SOC is the ability to bring into
play the generalized resistance resources available to him or her.
Levinson's tasks and Parkes's psychosocial transitions are seen
as challenges, sad and difficult as some of them may be, and
dealt with. For a short period, the level of entropy increases.
Bu t the very process of meeting the challenge, and the likeli-
hood of a successful outcome, restores the low level of disorder.
D
In citing the woman reported by Pearlin as having a hus-
E
band who drinks but is a steady worker, I pointed to two possi-
IA HT
ble developments. Let us assume that her earlier life experiences
had generated a strong SOC but that she had made what turned
out to be not exactly an idyllic marriage. Such mistakes are
ER RIG
made by all of us, although they are less likely for someone
L
with a strong SOC. I suggested the possibility of slamming the
door in her husband's face and rebuilding her life. The transi-
AT Y
which he has been working for twenty years cuts its R&D bud-
C
D
A general flavor of mild decay,
Bu t nothing local, as one may say ...
D
stressors. But if the degrees of freedom are very limited, he or
E
she may not be able to succeed. Thus a woman whose husband
IA HT
is transferred to a distant new community may find, cutoff
from her friends and community activities, her children having
ER IG
gone off to college, living in a social climate alien to her, that the
character of life experiences undermines her SOC. Or if, previous-
L
R
D
institutional, social, and cultural settings that shape people's
life experiences, it is utopian to expect that an encounter, or
E
even a series of encounters, between client and clinician can sig-
IA HT
nificantly change the SOC. One's orientation to the world,
fonned over the course of decades, is too deeply rooted a phe-
ER IG
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How the Sense of Coherence Develops over the Lifespan 125
D
days, or weeks. Harm is done. It is not permanent or decisive
but is damaging nonetheless. A patient with an SOC score of 80
E
will be, to put it crudely, knocked down to 75. And this will
IA HT
express itself, for example, in a greater need for pain medica-
tion, in an extra day or two of hospitalization. It is in these
ER RIG
done. -
Conversely, it is possible for the clinician to structure en-
C
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126 Unraveling the Mystery of Health
D
gestive. These approaches, however, are limited in , that they do
not, and cannot, seek to change the life situations of people
E
that shape their experiences. They do, however, enable people
IA HT
to begin to do more than reinterpret these experiences, in that
they equip people to seek out, within the scope of their lives,
ER IG
practitioner has a good deal of control over the client's life sit-
uation over a long period. In Coser's (1963) account of the re-
definition of a ward for the tenninally ill as a rehabilitation
C
D
for some and force others to encounter rapids and whirlpools?
E
And, whatever the character of the river we are in, what facili-
IA HT
tates the capacity to swim well and joyously for some and, for
others, makes even staying afloat a constant struggle?
ER IG
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6
Pathways Leading
to Successful
Coping and Health
E D
IA HT
"The fact is that there is a substantial gloss on this question in
the literature on social supports [why they have healthconse-
ER IG
1984, p. 21).
Such quotations can be multiplied. About a decade ago,
when the study of social supports was coming into vogue, re-
searchers were content with simply showing that there was a
relationship with illness. The next step was to conceptualize it
as a buffer between life events and illness, as a mediating vari-
able. This thinking was rooted in the stressor/illness tradition,
rather than linked to the more sociological Durkheimian tradi-
tion of anomie, which focused on the direct consequences of
lack of social rootedness. Recent data indeed indicate that so-
cial support seems to have direct, and not only buffering, ef-
fects in warding off illness (but see Lin, Woelfel, and Light,
1985). We now seem to be ready to tackle the questions of why
and how.
Bu t social support enthusiasts tend to forget that this is
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128
Pathways Leading to Successful Coping and Health 129
D
It is this very issue that led me to formulate the SOC con-
cept. What is important about GRRs, I proposed, is that they
E
provide life experiences that promote development and mainte-
IA HT
nance of a strong SOC. And, I would now add, what is impor-
tant about GRDs is that they provide experiences that vitiate
ER IG
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130 Unraveling the Mystery of Health
D
wide body of evidence from studies whose results "are at least
compatible with hypotheses that would be derived from the
E
concept of the sense of coherence." I added, "I have inten-
IA HT
tionally made no mention of the mechanisms and channels
through which the sense of coherence is related to health." I
ER IG
genic model was presented in full, this issue was briefly dis-
M P
cussed (pp. 193-194). The time has come to face the issue
O
squarely.
The fundamental philosophic view of the human organ-
C
D
instrumental and emotion-regulating problems come to the fore
E
of one's agenda. One has entered a state of tension. Whatever
IA HT
the stressor, then, one must act, much as in a state of cognitive
dissonance. Let us trace this process of action.
ER IG
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132 Unraveling the Mystery of Health
D
stimulus would be defined by all of us as stressor or nonstressor.
Called on unexpectedly at an international meeting of experts
E
to make spontaneous remarks is likely to put a graduate student
IA HT
into a tizzy; I would not be fazed. Approached seductively at a
party, one person would react with easy delight, another with
ER RIG
in tense tension.
The very first mechanism through which the SOC oper-
L
ate~, I propose, is related to this primary appraisal-I. By and
AT Y
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Pathways Leading to Successful Coping and Health 133
D
having had considerable experience in encountering stimuli
E
which initially seem to be stressors but soon tum out to be non-
problematic, without any particular investment of energy on
IA HT
her or his part, is more likely, at the primary appraisal-II stage,
to define a stressor as benign or irrelevant, to feel confident
ER IG
D
matters, to qualify the hypothesis that persons with a strong
E
SOC are more likely to define stimuli as nonstressors or as ir-
relevant ' or benign. In a detailed study of the trajectory from
IA HT
symptom perception to hospital care in the case of coronary
artery disease,Alonzo (1986, p. 1297) writes that "the time
ER IG
highest mortality from CAD occurs within the first hour after
AT Y
D
stressor may be appraised as happy or unhappy, as positive or
E
as endangering one's well-being. The literature overwhelmingly
IA HT
focuses on negative stressors, perhaps for good reason, since
reduction of suffering may n10rally be taken as having higher
ER IG
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136 Unraveling the Mystery of Health
fidence that things will work out, that one has the resources to
cope, that the confusing will become comprehensible, that the
potential for tension resolution exists-this confidence in and of
itself is a relevant resource.
Such confidence may well be linked to the second issue
to be raised: the nature of the emotional problem engendered
by a stressor. The same happy stressor will arouse different
emotions. The widower who meets an attractive woman and has
a strong SOC will feel hope and excitement; with a weak SOC,
he will experience ,hopelessness and apathy. The stressor ap-
praised as endangering will arouse, in the person with a strong
SOC, sadness, fear, pain, anger, guilt, grief, worry; in one with a
D
weak SOC, anxiety, rage, shame, despair, abandonment, bewil-
E
derment. What distinguishes these two sets of emotions is that
IA HT
the former provide a motivational basis for action, while the lat-
ter are paralyzing. Further, the former emotions are focused;
ER IG
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I
I
I
Pathways Leading to Successful Coping and Health 137
D
structure and lack of ambiguity in the perceived situation and"
second, affective appraisal of emotional involvement in the sit-
E
uation. In order to cope well, Shalit argues, one must both have
IA HT
a clear picture of the situation ("One can view the incoherence
of a perceived situation as the universal and primaty stress fac-
ER RIG
. situation.
M P
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138 Unraveling the Mystery of Health
Resolution 0f Tension
D
out; idiosyncratic, related to social roles or situations; or univer-
E
sal; chosen or imposed; and so on. To consistently adopt one
pattern of coping-to fight, to flee, or to freeze; to depend on
IA HT
others or on oneself; to use denial or rationalization ,or sublima-
tion; to depend on social supports or money or intelligence; and
ER IG
appropriate combination.
The notion of choice points to a distinction largely ig-
nored in the literature, particularly in that large bulk of work
done on coping which deals with social supports. I refer to the
distinction between a resistance resource as a potential asset and
the actual mobilization and utilization of a resource. True, the
very knowledge that one has a variety of potential resistance re-
sources at one's disposal is in itself a valuable asset. And it is
precisely the person with a strong SOC who is more likely to
have a considerable armamentarium of resources at his 'or her
disposal. But it is in the actual mobilization of what seems to
be the most appropriate resource or combination of resources in
the face of the given stressor that the true advantage of the
strong-SOC person comes to the fore.
The crucial factor involved in the process of mobilizing
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Pathways Leading to Successful Coping and Health 139
D
believes is a catastrophe. Of course we would rather these things
E
did not happen. Bu t they do. What is one to do, then, so that
the damage is minimal, so that the pain is assuaged?
IA HT
One possibility is to define the development as being be-
yond the boundaries of what is meaningful in one's life. One of
ER IG
rowed (or broadened)- always with the proviso that they can-
AT Y
D
lose its force, irrespective of what is done? This is precisely
where the comprehensibility component of the SOC comes into
E
play. Believing that problems can be ordered and understood,
IA HT
the strong-SOC person can set about turning chaos into order,
puzzlement into clarity. The weak-SOC person, persuaded that
ER IG
cess that brings the person to the stage of what Lazarus calls
secondary appraisal, this does not necessarily reflect the time
C
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Path ways Leading to Successful Coping and Health 141
D
The more recent literature has begun to demonstrate how
the same coping style, the same behavior pattern, the same de-
E
fense mechanism can be highly functional or severely dysfunc-
IA HT
tional in health terms, depending on the problem. Cohen (1984,
p. 269), reviewing a substantial number of studies that linked
ER IG
but rather how many are in his or her repertoire or how flexible
AT Y
D
ethos in American culture) that one must always actively con-
front reality in full and head on. Whatever philosophical validity
E
this position may have, its health consequences are problematic.
IA HT
But this is not to say that anything works well. In a study
of adults with four diseases having different levels of danger and
ER IG
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Pathways Leading to Successful Coping and Health 143
D
to the psychological and physical health of women and dele-
E
terious to the psychological and physical health of men" (p.
502). Black men, he argues, in the context of Southern racism,
IA HT
get into trouble when active, whereas women, whose major role
is that of the homemaker, cope successfully when active.
ER RIG
D
Reference to these studies and to those by Cohen (1984)
has been made in order to stress two points. First, the search
E
for the personality type or coping strategy that is universally
IA HT
effective in successfully dealing with stressors is not only use-
less; any such concrete type or strategy is bound to be self-
ER IG
defeating. But second, not anything goes. There are times and
places and situations and people where it is possible to say that
L
R
uses them flexibly and appropriately? This is, I suggest, the per-
son with a strong SOC. Motivated to cope, having clarified the
nature and dimensions of the problem and the 'reality in which
it exists, he or she is well on the road to managing, by select-
ing the most appropriate resources to the problem at hand.
Almost two decades ago Shanan (1967) proposed the
concept of an adaptive coping style, which he saw as a response
set that individuals characteristically adopt in stressful situa-
tions. He pointed to four features of this set; the availability of
free cathectic energy for directing attention to the sources of
potential difficulty; clear articulation of the perceptual field,
distinguishing between the internal and external environments
as potential sources of difficulty; confronting rather than avoid-
ing complexity and conflict in the external environment; and
maintenance of an optimal balance between the demands of
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Pathways Leading to Successful Coping and Health 145
D
prehensible is focused on the specific situation-one is ready to
E
act. Such action can be directed, simultaneously or sequentially,
IA HT
at solving the instrumental problem and the emotional load.
What does this mean, to use one of the examples given earlier,
ER IG
SOC: insisting that his union keep very careful track of any at-
M OP
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146 Unraveling the Mystery of Health
D
ciological characteristics of unemploy~ent that facilitate ill-
ness. In a brief passing remark (p. 36), however, he notes that
E
"a period of unemployment may be a useful turning point for a
IA HT
few individuals," but the question raised is nowhere pursued.
My point, of course, is not that unemployment is a happy ex-
ER IG
perience; quite the contrary. But, for the person with a strong
L
SOC, it may be less damaging and may even prove to be salutary.
R
D
being transformed into stress. An orientation toward one's
world that sees stimuli as meaningful, comprehensible, and man-
E
ageable provides the motivational and cognitive basis for behav-
IA HT
ior that is more likely to resolve the problems posed by stressors
than is one that sees the world as burdensome, chaotic, and
ER IG
overwhelming.
L
In seeking to understand how the SOC works, it may be
R
"weak" SOC, I trust it has been obvious that this was simply a
parsimonious way of sayin:g, "The higher one is on the SOC con-
tinuum,the more likely is it ... " Second, the actual content of
behavior, of the resources chosen to cope with stressors, is al-
ways shaped by one's culture. The concept may be cross-cultural,
but its . concrete translation will vary widely. Thus the confi-
dant( e) may be a relative of the older generation, a holy per-
son, a spouse, God, or a friend. Similarly, one's culture defines
which resources are appropriate arid legitimate in a given situa-
tion. Culture sets limits; within these limits, the SOC matters.
Third, I hope it has not been inferred from what I have written
D
that ~ strong SOC is a magic bullet, enabling one to fully solve
E
all the problems in life posed by stressQrs. Not only do very few
of us have a very strong, authentic SOC, many of the problems
IA HT
in life are in tractable, not amenable to full solution no matter
how strong one's SOC. What I have proposed is that people with
ER IG
a strong SOC will do better than those with a weak SOC in cop-
L
ing with these problems; that when a problem is not soluble,
R
D
implication of a stimulus for one's well-being. It is in this sense
E
that I see the problem of regulation of emotion. Once we have
appraised a stimulus as a stressor, as having implications for our
IA HT
well-being, a set of feelings emerges. How does the SOC allow us
to cope successfully with emotions?
ER IG
life, people in general. One boils in anger, and the steam dissi-
pates; one seethes in rage, endlessly. Similar contrasts exist be-
tween fear and anxiety, between grief and the feeling of having
been abandoned. In each case, it is easier to figure out what to
do about the one emotion than about the other.
A second distinguishing characteristic of the emotions is
the extent to which they are at the level of the unconscious.
The strong-SOC person is more likely to be aware of his or her
emotions, can more easily describe them, feels less threatened
by them. They are more likely to be personally and culturally
acceptable; hence there is less need to disregard their existence.
D
They are more appropriately responsive to the reality of the sit-
uation one is in.
E
Third, there are the many stressors that raise the attribu-
IA HT
tional question of blame. The weak-SOC person is more likely
to blame someone or something else, often a vague "they" or
ER IG
the assumption is often made that the job demands are reason-
able and the problem is to train the worker to adjust to the
stressors, conveying the message that he or she is to blame. (See
Sch wartz, 1980, who devotes part of one paragraph to "proce-
dures ... geared toward helping people change their environ-
ment to be more healthful" (p. 101), referring largely to assert-
iveness training and anger control, and more than three and a
half pages to procedures "geared toward helping people cope
with an environment that cannot be changed" (pp. 101-102).)
The weak-SOC person, deeply unsure of his or her own compe-
tence, will often buy this approach, in contrast to the strong-
SOC person, capable of placing the blame where it belongs .
.We may take the issue of attribution one step further.
When one does blame oneself, the target may be charactero-
logical or behavioral. In a study of women who came to an
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Pathways Leading to Successful Coping and Health 151
D
not that the former does not, in response to negative stressors,
E
have strong feelings of emotional distress. If anything, he or she
is more likely to allow them to come to the surface and to ex-
IA HT
press them in overt behavior, rather than to repress them. In
this way, one can more easily both act to deal with the instru-
ER IG
Effects on Health
ease continuum has not even been mentioned. Yet the whole
point of the discussion has been that by managing tension well,
the person with a strong SOC will indeed reinforce or improve
his or her health status. But as Kaplan warns (1984, p. 756), "a
study that focuses on coping strategies is of little value unless
we know that these strategies mediate heal th." It is to this issue
that I now tum directly.
When John Snow urged closing the Lambeth Company's
Broad Street pump in order to contain the cholera epidemic in
London in 1853, he had formulated the hypothesis that cholera
could be transmitted ~y discharge of fecal wastes into water
D
supplies (Snow, 1855). He was very far from understanding the
E
mechanisms by which using water in to which sewage had been
dumped led to cholera. But the epidemiologic basis for his rec-
IA HT
ommendation was sound. Similarly, there seems to be sufficient
evidence that stressors, unless adequately coped with, are patho-
ER IG
which coping can affect the etiology of and recovery from dis-
ease" (1984, p. 265). Three of these are on the level of direct
behavioral coping:
D
we can ask: Confronted with an acute or chronic stressor, who
is more likely to respond behaviorally with maladaptive health
E
behavior, such as increased smoking or drinking, denial of symp-
IA HT
toms, and nonadherence to medical regimens, and who is more
likely to respond behaviorally with adaptive health behavior,
ER RIG
D
talking about, entering a field about which I know next to noth-
ing. M"o reover, even experts in the field grant that there is as yet
E
very little definitive knowledge available. Nonetheless, if any
IA HT
progress is to be made, social and biological scientists must learn
to talk to each other. We cannot become experts in the other's
ER IG
lIn a most detailed recent review of what is known about the bio-
logical substrates of stress, Ciaranello and others (1982, p. 240) conclude:
"Cooperation among biological, psychological, and social scientists could
be tremendously valuable, because each of these fields offers a different
perspective of stress. Such collaborations are especially vital for efforts to
identify and characterize important mediators of stress." It is in the hope
that the SOC may be such a mediator that I have included this section.
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Pathways Leading to Successful Coping and Health 155
D
person need not even be aware. The external environment pro-
E
vides input stimulation to the system; through sensory recep-
IA HT
tors, these inputs are registered in and processed by the brain
(the information-processing subsystem); the brain, in turn,
transmits orders to "peripheral organs" designed to cope ade-
ER IG
quately with the demand that has been made on the system;
L
R
cation that the problem has not been solved, the brain con-
C
D
damage begins. Introduction of the time dimension allows us to
E
focus not on the response to the acute stressor, which arouses
IA HT
physiological deviations from a steady state but can be handled
expeditiously, but on the repeated acute or chronic stressors,
inadequately handled, which are the source of damage.
ER IG
noted, the person with a strong SOC is more likely to avoid en-
M OP
D
that at a biological substrate, the SOC is expressed in a balanced
E
integration between the two hemispheres. The reader will per-
haps recall the phrase I used in referring to the comprehensibil-
IA HT
ity and meaningfulness components of the SOC: "making
sense." I suggested that, for the strong-SOC person, the world
ER IG
they are not wild speculation; they do not violate the little that
is known. Most important of all, they give us a way of thinking
that generates hypotheses to be tested.
This brings us, finally, to a more precise focus on the rela-
tionship between adequate regulation and the maintenance of
health (although, as always, the emphasis in the literature is on
disregulation and disease processes). In the last two decades,
there has been a most exciting explosion in a field that is com-
ing to be called psychoneuroimmunology. All those involved
would agree that "the concept that the immune system, operat-
ing via the central nervous and neuroendocrine systems, may act
as a 'transducer' between experience and disease" (Solomon,
1985, p. 7) is no longer an alien, speculative concept, even
though knowledge is just at the beginning stage.
In his recent review of the field, Solomon proposes four-
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158 Unraveling the Mystery of Health
D
ior pattern, would not predict to specific diseases but to dis-
E
ease. Cannot we then infer that there is · also an "immuno-
IA HT
enhancement-prone" personality? Is nota person with a strong
SOC a candidate for the kind of person who, confronted with
ch?1]enge to the integrity of the organism, mobilizes immuno-
ER IG
logical competence?
L
Solomon's second hypothesis refers to the consequences
R
D
tion acceptor' involving the hippocampus and frontal areas of
E
the cerebral cortex. The operation of this action acceptor leads
IA HT
to the development of integrated somatic-behavioral and vis-
ceral-endocrine adaptive responses, at which · point the hippo-
campal electrical desynchronization disappears. The informa-
ER RIG
D
ceptional conditions, where the stress was maximum and the
E
reserves were subject to maximum depletion, it was more appar-
IA HT
ent than under normal circumstances to what an extent the
neural and neurohumoral regulation of internal processes in the
organisms depends on the psychic processes." And further, in
ER IG
view. "
O
D
patients under general anesthesia, however, showed increased
E
cardiovascular responses "under conditions where conscious
perceptual mediation is minimized"; that is, "the impatience,
IA HT
hostility, and speech patterns exhibited by Type A individuals
may, in part, reflect an underlying sympathetic nervous system
ER RIG
D
health ease/dis-ease continuum to the GRRcolumn. This chap-
ter has been devoted to tracing the pathways through which the
E
SOC leads to health. But one's state of health is itself a signifi-
IA HT
cant life situation GRR-RD and, as such, plays a role in strength-
ening or debilitating the SOC. This point had been made explic-
ER IG
present chapter.
AT Y
M PO
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7
Solving the Mystery:
Issues for Further Exploration
E D
In the course of writing Health, Stress, and Cop£ng and papers
IA HT
written since then, and in the preparation of this book, as well
as in many exchanges with colleagues, a number of meaningful
ER IG
163
164 Unraveling the Mystery of Health
D
of Mistress Elizabeth Drury" (1611)
E
IA HT
The central thesis of the salutogenic model is that a
strong SOC is crucial to successful coping with the ubiquitous
stressors of living and hence to health maintenance. If this the-
ER IG
D
ing with closed physical systems and the universe as a whole, re-
jected the timelessness of the mechanistic image, pointing to a
E
unidirectional process of increasing disorder and eventual death.
IA HT
Darwinism, in contrast, · pointed to the increasing complexity
and, presumably, increasing order of biological systems. Ein-
ER IG
does not play dice with the world, he is reputed to have said.
AT Y
beau ty, retains a strong hold on all the sciences, despite the
O
D
tems and suprasystems, does one separate information from
noise, make sense of one's world? For if one does not, if one
E
does not succeed in some adequate level of filtration, "one"-
IA HT
the system-will inexorably go mad and die.
Gardner (1979, pp. 254-255) sees the universe as a rich
ER IG
systems, things are winding down, but there are some peculiar
AT Y
pockets where things are winding up, complexity and- order in-
M OP
D
tropy is maximized, and essentially is an expression of total
E
disorder, quiescence, and death. Open systems, defined as hav-
IA HT
ing borders permeable to energy, matter, and information, are
thus by definition not irrevocably doomed to death. Cannon,
using Spencer's idea of moving equilibration, introduced · the
ER IG
concern was with the mechanisms of how the part of each sys-
tem contributed to maintaining the functioning of the system
AT Y
D
concept of coherence and begun to realize the fruitful implica-
E
tions of asking not only "How does chaos emerge?" but also
IA HT
"How does order emerge?"
This is precisely the problem confronted by Sampson
ER IG
D
as pointing in precisely the same direction as nonequilibrium
E
theory in physics. Only if we view literature as totally open-
ended, multiple-meaning texts, with reading as a dialogue over
IA HT
time between text and reader, with no absolute fixed textual
reality, can coherence and order be approached. Subsequently,
ER IG
D
set as a goal moving closer to an integrated theory that proposes
E
how any system copes with its reality?
IA HT
The SOC as a Group Property
ER IG
i,
D
cause a "reliable informant" has told us? Or because we have
E
made our own observations? Or because we have conducted a
IA HT
survey and "most" (60 percent? 80 percent? 93 percent?) peo-
ple say this is what they think? The problem is at its most diffi-
cult when we come to talk of a Zeitgeist, a Weltanschauung, a
ER IG
climate, an ambience.
L
Throughout Health, Stress, and Coping, my consistent
R
coherence can characterize any social unit, from the Jones fam-
ily to a neighborhood, a city, a region, or a country; from a
local voluntary association to an apocalyptic religious move-
ment; from underdogs to overdogs."
Does this make sense? Can it mean anything more than
measuring the SOC of the individuals making up the group and
reporting that the mean level of this group is higher than of
that, or that the former has a higher proportion of persons with
a strong SOC than the latter? Or that the variance of one is great-
er than that of the other? Can a collectivity, as such, be charac-
terized as having a common way of seeing the world? The im-
portance of the question becomes clear when we consider that if
the answer is positive, we can reasonably hypothesize that this
way of seeing the world becomes an independent variable in
shaping the SOC level of the members of the collectivity. But if
this hypothesis is to be more than tautological, the group SOC
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-- ~
D
her world" (p. 181). It is the individual who feels alienated,
E
powerless, meaningless, socially isolated, whatever the structural
IA HT
or historical sources of this image of the world. In other words,
a collective is "alienated" only when a large proportion of its
members are alienated, or, alternatively, a higher proportion
ER IG
D
gent collective trait- can also operate on the individual level,
E
but becomes collective when possessed by multiple interacting
IA HT
members." He sees morale as such an emergent collective trait,
a counterpart to individual satisfaction. The data to measure
ER IG
D
extent to which husband and wife, respectively, perceived the
E
family as having a strong SOC, were indeed very powerful pre-
IA HT
dictors to our measures of rehabilitation. Moreover, there was a
very high though not perfect correlation between the spouses'
ER IG
agreement between the husband and wife that the family SOC
AT Y
was strong. That is, both the level of perception and the agree-
M P
D
very coherently, others assign a moderate score to the group,
and still others see the group as having a totally confused image
E
of the world)? Or (2) the group in which there is general con-
IA HT
sensus about group incoherence? I am afraid this is a question
to which I am not yet ready to give an answer.
ER IG
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176 Unraveling the Mystery of Health
D
-one can legitimately see the SOC as a group property. What
E
characterizes these collectivities is that whatever individual dif-
IA HT
ferences and cross-cu tting affiliations may exist, membership in
the collectivity is of overriding centrality in the lives of its mem-
bers. For each, the self and the social identity are deeply inter-
ER IG
woven.
L
R
D
the individual? There are two reasons for a positive answer.
E
First, as implied earlier, the group SOC may well be a sig-
IA HT
nificant factor in shaping and modifying the SOC of the individ-
ual. This would be particularly true for the child or adolescent.
ER IG
D
are important human problems, such as those that we have seen
E
in occupation [jobs], that are not responsive to individual cop-
IA HT
ing responses. Coping with these may require interventions by
collectivities rather than by individuals. Many of the problems
stemming from arrangements deeply rooted in social and eco-
ER IG
D
cluding mental health in this continuum, although in a recent
E
paper (Antonovsky, 1985), I discuss the possible link between
IA HT
the SOC and mental health. Iwas wary of proposing a hypothe-
sis linking the SOC to "everything that can possibly be regarded
by someone, or in some culture, as desirable" or of "defining
ER IG
lems, I think we can agree with Zautra and Hempel that there is
a relationship between health and well-being which is more than
likely to be reciprocal. If the SOC is indeed related to health,
should it not then reasonably be expected to be related to a
variety of aspects of well-being? If successful coping with life
stressors has positive consequences for health, should it not also
have positive consequences for satisfaction, happiness, morale,
and positive affect?
We can take the question a step further. Should we not
also expect positive consequences of a strong SOC for task per-
fonnance? Payne (1980, p. 270), for example, reports that peo-
D
ple who "participate in decisions affecting them are more likely
E
to report ... high utilization of skills." Shalit's work (1982), re-
IA HT
ferred to earlier, has shown how "coherence of appraisal" is
related to the effectiveness of military groups. In both cases, the
independent variables are conceptually related to the SOC.
ER IG
and so forth?
O
to all these facets of well-being and the good life through health,
although this may well be true. It is, rather, whether it is plausi-
ble to hypothesize a direct, causal link between the SOC and
these aspects of well-being.
Readers of Health, Stress, and Cop£ng will recall the
source of the SOC concept. I had not started with the idea of
explaining well-being, task perfonnance, or the ability to work,
love, and play well. Nor was the SOC a theoretical notion that I
started with, asking about its consequences for human life. Hav-
ing been immersed for many years in seeking to understand the
contributing role of psychosocial factors in, first, diseases, then
in dis-ease, and finally in location on the health ease/dis-ease
continuum, I had become familiar with the various theoretical
and empirical studies that linked what I came to call GRRs to
health outcome. The SOC concept was the result of, first, an at-
tempt to understand what was common to all the GRRs and,
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Solving the Mystery: Issues for Further Exploration 181
D
not because one has a strong SOC but because one has a satis-
factory income.
E
IA HT
In sum, I think it reasonable to expect positive, though
not directly causal, correlations between the SOC and well-
ER IG
SOC are also directly related to well-being. But there is, I think,
M OP
D
able. Thus, assuming that the task is within the boundaries of
E
what matters to the person, it is indeed likely that there will be
IA HT
some contribution of the SOC to outcome.
I have, then, gone beyond my original position that dealt
ER IG
ing the SOC to other aspects of well-being but will not be too
M OP
D
authority figures on the two axes of egalitarianism-hierarchical
and specificity-diffuseness. Or one can speak of prototypical
E
bases for self-esteem: who one is, what one has done, or what
IA HT
one is like. Or one can speak of a tendency toward basic trust or
mistrust, cross-cut by the social boundaries of the trust. Thus,
ER RIG
I
184 Unraveling the Mystery of Health
D
Seeman's (1983, p. 172) discussion of the alienation con-
E
cept considers this issue. Replying to those who reject the con-
IA HT
cept because they believe that it refers "to a stable, almost
immutable, quality of the individual, to a personality 'trait' that
exists as a feature of the person's inner life independent of sit-
ER RIG
D
ward. \\That must be further emphasized is that full sensitivity
E
to the importance of the social context of one's life and the re-
IA HT
sponses it tends to elicit does not mean that one can disregard
the extent to which people are active agents. Given the same sit-
uation, the person with a strong SOC will tend to search out
ER IG
D
person will tend to seek to impose structure on the situation,
E
even when to the outside observer there is little structure; will
IA HT
tend to search for what seems to him to be the appropriate
GRRs and SRRs that may facilitate coping with the situation;
will tend to consider options within his canon; will tend to be-
ER RIG
D
ways to use energy." This contrasts sharply to those who, over
their lifetimes, manifest "event construal patterns characterized
E
by helplessness, hopelessness, and fear," leading to passive,
IA HT
shrinking behaviors.
There is, then, no one-to-one relationship between the
ER IG
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1 i
, I,
I·
I: I
1
,
'
, ,
, I
i, I
E D
IA HT
The notation to the left of each item represents the pro-
file structure of the item, derived from the mapping sentence
ER IG
respectively.
M OP
,i
,'
ill
·1
,'I"
i:
: '
This copy is intended for use of the recipient only, whose name is encrypted in the file.
189
ORIENTATION TO LIFE QUESTIONNAIRE
Here is a series of questions relating to various aspects of our lives. Each question has seven possible answers. Please mark the
number which expresses your answer, with numbers 1 and 7 being the extreme answers. If the words under 1 are right for you,
circle 1; if the words under 7 are right for you, circle 7. If you feel differently, circle the number which best expresses your feel-
ing. Please give only one answer to each question.
C R 1. When you talk to people, do you have the feeling that they don't understand you?
D
1312 1 2 3 4 5 6 7
E
never have always have
I A HT
this feeling this feeling
MA 2. In the past, when you had to do something which depended upon cooperation with others, did you have the feel-
1111 ing that it:
ER IG
1 2 3 4 5 6 7
L
surely wouldn't surely would
R
get done get done
AT Y
C 3. Think of the people with whom you come into contact daily, aside from the ones to whom you feel closest. How
M P
1322 well do you know most of them?
O
1 2 3 4 5 6 7
you feel that you know them
C
ME R *4. Do you have the feeling that you don't really care about what goes on around you?
1222 1 2 3 4 5 6 7
very seldom very often
or never
C R * 5. Has it happened in the past that you were surprised by the behavior of people whom you thought you knew
1221 well?
1 2 3 4 5 6 7
never always
happened happened
This copy is intended for use of the recipient only, whose name is encrypted in the file.
~
MA R *6. Has it happened that people whom you counted on disappointed you?
1221
1 2 3 4 5 6 7
never always
happened happened
ME R 7. Life is:
2332 1 3 4 5 6 7
2
full of completely
in terest routine
D
ME * 8. Un til now your life has had:
E
2331 4
1 2 3 5 6 7
I A HT
no clear goals or very clear goals
purpose at all , and purpose
ER IG
MA *9. Do you have the feeling that you're being treated unfairly?
1222
L
1 2 3 4 5 6 7
R
very often very seldom
AT Y
or never
C
M P
10. In the past ten years your life has been:
2331
O
1 2 3 4 5 6 7
full of changes completely
C
ME R 11. Most of the things you do in the future will probably be:
1313 1 3 4 5 6 7
2
completely deadly
fascinating boring
This copy is intended for use of the recipient only, whose name is encrypted in the file.
C >Ie 12. Do you have the feeling that you are in an unfamiliar situation and don't know what to do?
2232 1 2 3 4 5 6 7
very often very seldom
or never
D
ME R 14. When you think about your life, you very often:
E
2132 1 3 4 5 6 7
2
I A HT
feel how good it ask yourself why
is to be alive you exist at all
ER IG
G 15. When you face a difficult problem, the choice of a solution is:
1112 3 4 5 6 7
1 2
L
R
always confusing always completely
and hard to find clear
ME R * 16.
AT Y
Doing the things you do every day is:
M OP
1312 1 2 -3 4 5 6 7
a source of deep a source of pain
and boredom
C
pleasure and
satisfaction
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MA 18. When something unpleasant happened in the past your tendency was:
3211 1 2 3 4 5 6 7
"to eat yourself to say "ok,
up" about it that's that, I
have to live with
it," and go on
D
MA R 20. When you do something that gives you a good feeling:
E
1113
1 2 3 4 5 6 7
IA HT
it's certain that it's certain that
you'll go on something will
feeling good happen to spoil
ER IG
the feeling
L
C *21. Does it happen that you have feelings inside you would rather not feel?
R
3122
1 2 3 4 5 6 7
AT Y
very often very seldom
or never
M P O
ME 22. You anticipate that your personal life in the future will be:
2333
1 2 3 4 5 6 7
C
MA R 23. Do you think that there will always be people whom you'll be able to count on in the future?
1223
1 2 3 4 5 6 7
you're certain you doubt
there will be there will be
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_.--_.---"
- - - - -.-- -
.... --- - .. - - - --~. "---- ~ -
~---- -.-.-.-.--::--:-:-:---::-~-- .. - -- . __ . - --
C 24. Does it happen that you have the feeling that you don't know exactly what's about to happen?
2233 1 4
2 3 5 6 7
very often very seldom
or never
MA R *25. Many people-even those with a strong character-sometimes feel like sad sacks (losers) in certain situations. How
3131 often have you felt this way in the past?
1 2 3 4 5 6 7
never very often
D
C *26. When something happened, have you generally found that:
E
1211 1 2 4 5
3 6 7
I A HT
you overesti- you saw things
mated or under- in the right
estimated its proportion
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importance
L
R
MA R 27. When you think of difficulties you are likely to face in important aspects of your life, do you have the feeling
1313 that:
1
AT Y 2 3 4 5 6 7
you will always
M OP you won't
succeed in over- . succeed in over-
coming the coming the
C
ME *28. How often do you have the feeling that there's little meaning in the things you do in your daily life?
1212 1 2 3 4 5 6 7
very often very seldom
or never
MA * 29. How often do you have feelings that you're not sure you can keep under control?
3122 1 2 3 4 5 6 7
very often very seldom
or never
D
Adler, P. T. "An Analysis of the Concept of Competence in In-
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dividuals and Social Systems." Commun£ty Mental Health
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Journal, 1982,18, 34-45.
Albrecht, T. L., and Adelman, M. B. "Social Support and Life
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195
... '+'
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Antonovsky, H., and Sagy, S. "The Development of a Sense of
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Coherence and Its Impact on Responses to Stress Situations."
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Journal of Social Psychology, 1986,126, 213-225.
Antze, P. "Role of Ideologies in Peer Psychotherapy Groups."
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Bass, 1979.
AT Y
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Boyce, W. T., Schaefer, C., and Vitti, C. "Permanence and
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193-200.
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L
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C
This copy is intended for use of the recipient only, whose name is encrypted in the file.
Index
E D
A Appraisal Integration Model (AIM),
60-61
IA HT
Adelman, M. B., 116 Asthma, and salu tary factors, 6
Adler, P. T., 173 Auschwitz, and SOC, 21, 160, 185
Adolescence: and fundamentalist
ER RIG
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210
Index 211
D
Carlstedt, L., 137 Control, and SOC, 36-37,48,52
Cassel,J., 8, 33, 91, 146 Coordination, and SOC, 46-47, 48,
E
Cassell, E.J., 5, 10,34 49
IA HT
Causality, and story of person, 5 Coping: active or passive, 143; adap-
Challenge, and SOC, 37-38, 48, 51 tive, 144-145; analysis of con-
Chaplin, C., 114 nections with health, 128-162;
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212 Index
D
Edwards Personal Preference Sched- G
ule, 87
E
Einstein, A., 165, 170 Gaddafi, M., 106
Elderly: social world for, 143-144; Galdston, 1., 89
IA HT
and stamina, 186-187 Gardell, B., 126
Emotions: coping with, 148-151; Gardner, M.,-166
focused or diffuse, 149-150; and Garmezy, 43-44
ER RIG
Equilibrium, and order out of chaos, 28; and dynamics of SOC, 121;
167-170 importance of, 129; and life ex-
Erikson, E. H., 34, 95, 97, 101-102 periences, 91-92; and well-being,
External Locus of Control Scale, 37 180-181
Gentry, W. D., 90
F Glaser, B. G., 63
,Groups: as identifiable, 175-176;
Facet design, in questionnaire draft- and individual health, 177-178;
ing, 76-78, 82 SOC as property of, 170-179;
Fagin, L., 146 and size, 175
Faigin, H., 100 Goal orientation, and SOC, 42, 48,
Family: reality constructed by, and 52
SOC, 45-47,52; SOC of, 174 Guttman, 76, 77
Family Environment Scale, 53-54
Feedback, and coping, 146-147, H
156, 159
Felton, B. J., 142 Haan,N., 136
Feuer, L. S., 106 Hamann,J. G., 165,170
Field, T. M., 94 Hardiness: and immune system,
Fiorentino, L. M., 86 158; and SOC, 35-38, 51
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Index 213
D
and story of person, 4-5; and Israel: adaptation in, 9-10; group
E
stressors, 7-8; and well-being, SOC in, 177, 178-179; measur-
179-182 ing SOC in, 64-75, 80-81, 84-85,
IA HT
Health, Stress, and Coping, 2-3, 7, 86, 87; social environment in,
8, 14, 15, 16, 17, 18, 19, 22, 24, 100; survey in, 19; work roles in,
27-28, 33, 50, 63, 64, 65, 66, 110
ER IG
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214 Index
D
Manageability: in adolescence, 102;
L comparisons with, 48,51-53,59;
E
as component of SOC, 17-18;
Laudenslager, M. L., 1, 2n comprehensibili~ and meaning-
IA HT
Lazarsfeld,P. F., 171,176 fulness related to, 19-22, 86-88;
Lazarus, R. S., 30, 55, 60, 61, 131, and group SOC, 174-175, 176;
ER IG
fication of SOC, 126; and SOC, 76-79; and strength and rigidity,
59 25, 26; and stressors, 137, 147;
M P
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Index 215
D
Mormons, and strong SOC, 25 Payne, R., 180
E
Moscovici, 172 Pearlin, L. 1., 23,55, 119, 121, 122,
Mueller, P., 151 178
IA HT
Mullan,j. T., 55 Pepe, V., 136
Multidimensional Health Locus of Permanence: and harmonious con-
Control (MHLC), 85 tinuity, 50; and SOC, 39-40
ER IG
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216 Index
Rumbaut, R. G., 82-83, 84, 85, 86 nents of, 16-19; and contexts of
Rutter, M., 94 life experiences, 89-94; critical
spheres in, 23; cross-cultural
study of, 78n, 79-82; cultural
S limits for, 148; defined, 19; de-
velopment of, over lifespan, 89-
Sagy, S., 85, 86, 178 127; emergence of, 164; · and
Saltzer, E. B., 59 family construction of reality,
Salutogenesis: advantages of, 2; 45-47,52; as group property,
analysis of, 1-14; assumptions in, 170-179; and hardiness, 35-38,
2-3; comparisons with, 47-54; 51; health effects of, 151-162;
consequence of, 13; and etiology in infancy and childhood, 39-40,
and diagnosis, 9-11; issues in, 43-45, 94-101; and integrity, 34;
163-187; metaphor for, 89-91, issues of, 163-187; and lifespan,
D
127; and order out of chaos, 163- 119-127; and locus of control,
170; and other views of health, 37,45,48,52,53; mapping sen-
E
33-35; partial affinities with, 54- tence for, 77-78; modification
IA HT
62; pathogenesis related to, 12- of, 123-127; normative data on
14; and pathways connecting scale for, 79-82; and other views
coping and health, 128-162; sum- of health, 33-62; and pathways
ER IG
Sayles, M., 128, 142 157; pilot study for, 64-75; and
AT Y
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Index 217
D
Stamina: and elderly, 186-187; and Thomas, C. B., 57-58
SOC, 58 Trait, SOC as, 182-187
E
Stariford University, Social Ecology Type A behavior pattern: and bio-
IA HT
Laboratory at, 31 logical substrate, 161; and coro-
State, SOC as, 182-187 nary heart disease, 6, 11
State-Trait Anxiety Inventory, 85
ER IG
This copy is intended for use of the recipient only, whose name is encrypted in the file.
218 Index
E D
IA HT
ER IG
L
R
AT Y
M OP
C
This copy is intended for use of the recipient only, whose name is encrypted in the file.